Healthcare Provider Details

I. General information

NPI: 1114575008
Provider Name (Legal Business Name): AGAPE'S LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16682 N WEST POINT PKWY APT 123
SURPRISE AZ
85374-4056
US

IV. Provider business mailing address

16682 N WEST POINT PKWY APT 123
SURPRISE AZ
85374-4056
US

V. Phone/Fax

Practice location:
  • Phone: 602-824-8352
  • Fax: 602-325-0339
Mailing address:
  • Phone: 602-824-8352
  • Fax: 602-325-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JASMINE THOMAS
Title or Position: MANAGER
Credential:
Phone: 602-824-8352