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Organization

BLUE AGAVE WOUND CARE SOLUTIONS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RICHARD CARNEY (MEMBER LLC)
(619) 568-6800
Entity
Organization

Contact information

Practice address
10109 LAKE CREEK PKWY UNIT 170434, AUSTIN, TX 78717-0119
(844) 275-3822
Mailing address
PO BOX 170434, AUSTIN, TX 78717-0027
(844) 275-3822

Taxonomy

Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
163WW0000X
Wound Care Registered Nurse
Primary
363L00000X
Nurse Practitioner
364SH0200X
Home Health Clinical Nurse Specialist
374U00000X
Home Health Aide

Other

Enumeration date
11/05/2018
Last updated
11/05/2018
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