Agave Home Health LLC
Organization Active NPI Home Health Agency · Alpine, TX
NPI 1326324401 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1326324401
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 015776 (TX)
- Legal business name
- AGAVE HOME HEALTH LLC
- Practice address
- 610 E Holland Ave
Alpine, TX 79830-4830 - Phone
- (432) 837-5907
- Fax
- (866) 523-1745
- NPI assigned
- Nov 2, 2011
- Organization subpart
- No
Authorized official
- Name
- Angela B Juett
- Title
- Administrator/Owner
- Phone
- (432) 837-5907
Subparts reporting this organization as parent 1
Practitioners 12
-
Rachel Guenat, P. T.
-
Elizabeth Mesker, SLP
-
Laura Snodgrass, OTR
-
Joanie Marie Weber, P.T.
-
Edgar Allan Liwanag Benusa, PT, DPT
-
Wikar A Kadhim, OT
-
Holly McMurray, PT, DPT
Affiliated clinicians 5
-
Patrick W Daly, M.D.
-
Ruth Melody Hornady, APRN, AGACNP
-
James Luecke, MD
-
Jose Manuel Soto-Hernandez, APRN-NP
Medicare Care Compare: Home health agency
- Listed as
- Agave Home Health LLC
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Proprietary
- Certified
- Oct 7, 2013
- Medicare certification status
- Active
- Services
- Nursing, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2033976 | Agave Home Health, LLC | Certificate of waiver | Dec 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Home health agency certification: CCN 747914
- Legal name
- AGAVE HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Oct 7, 2013
- Last certification
- Dec 18, 2019
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 1, 2011 in TX
- Enrollment address
- 610 E Holland Ave
Alpine, TX 79830-4830
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Cynthia Kirkpatrick |
W-2 Managing Employee |
Mar 1, 2016 | |
| Angela Juett |
5% Or Greater Direct Ownership Interest |
Nov 1, 2011 | 50% |
| Corporate Director |
Nov 1, 2011 | ||
| W-2 Managing Employee |
Nov 1, 2011 | ||
| William Juett |
5% Or Greater Direct Ownership Interest |
Nov 1, 2011 | 50% |
| Corporate Director |
Nov 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120726000477 | TX | Part a Provider - Home Health Agency | 2860658481 | Practice locations: Alpine, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| Home Health Agency | 251E00000X | 015776 | TX | Yes |
Addresses
Primary practice location
610 E Holland Ave
Alpine, TX 79830-4830
Mailing address
610 East Holland Ave.
Alpine, TX 79830
Phone (432) 837-5907
Other providers in Alpine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.