MEDICARE: AGAPE HOMES OF RHODE ISLAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1669102463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE HOMES OF RHODE ISLAND LLC

Provider Business Mailing Address
First Line	:	6 ALCAZAR AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-4039
Country	:	US
Telephone Number	:	401-447-8569
Fax Number	:	401-409-2162

Provider Business Practice Location Address
First Line	:	6 ALCAZAR AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-4039
Country	:	US
Telephone Number	:	401-447-8569
Fax Number	:	401-409-2162

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MODUPE O WILLIAMS
Credential	:	FNP
Telephone Number	:	401-447-8569

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	03/22/2026

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