Provider Demographics
NPI:1174343206
Name:AGORA CARE WEST LLC
Entity type:Organization
Organization Name:AGORA CARE WEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-778-4843
Mailing Address - Street 1:1606 HEADWAY CIR STE 9530
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5123
Mailing Address - Country:US
Mailing Address - Phone:469-778-4843
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE STE 1808
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2322
Practice Address - Country:US
Practice Address - Phone:469-778-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGORA CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty