Organization Name: | AGAVE GROUP, LLC |
NPI Number: | 1295027399 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEJANDRO PRIETO (OWNER) |
Mailing Address: | 9777 E Ocotillo Rim Trl Vail |
State: | AZ US |
Postal Code: | 856412142 |
Phone Number: | 5204443354 |
Fax Number: | |
NPI Enumeration Date: | 05/06/2011 |
NPI Last Update Date: | 05/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | AL7851H |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |