Agave Health Care LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

AGAVE HEALTH CARE LLC

Practice address

1647 Horlacher Ave
Dayton, OH 45420-3234

Phone

(480) 572-5133

NPI assigned

Aug 5, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nandebwa Yvonne Gipanga, MS

Title

Ceo

Phone

(480) 572-5133

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1225868326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 HORLACHER AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454203234",
            "telephone_number": "480-572-5133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 HORLACHER AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454203234",
            "telephone_number": "480-572-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-03",
        "status": "A",
        "authorized_official_last_name": "GIPANGA",
        "authorized_official_first_name": "NANDEBWA",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-572-5133",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Dayton, OH
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• Home Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.