MEDICARE: AGAPE HOUSECALLS PA

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1831723816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE HOUSECALLS PA

Provider Business Mailing Address
First Line	:	1312 14TH ST STE 101
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6206
Country	:	US
Telephone Number	:	972-248-3191
Fax Number	:	972-248-3198

Provider Business Practice Location Address
First Line	:	1312 14TH ST STE 101
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6206
Country	:	US
Telephone Number	:	972-248-3191
Fax Number	:	972-248-3198

Authorized Official
Title or Position	:	OWNER
Name	:	JOY ACKLIN
Credential	:	DO
Telephone Number	:	214-210-2911

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	03/18/2020

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Directions to “AGAPE HOUSECALLS PA ” Practice Location

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