Healthcare Provider Details

I. General information

NPI: 1205967403
Provider Name (Legal Business Name): AGAPE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54783 ME RD
COLLBRAN CO
81624-9722
US

IV. Provider business mailing address

54783 ME RD
COLLBRAN CO
81624-9722
US

V. Phone/Fax

Practice location:
  • Phone: 970-250-5655
  • Fax: 970-487-3231
Mailing address:
  • Phone: 970-250-5655
  • Fax: 970-487-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10H563
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier63081750
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: CHAN P REID
Title or Position: MANAGER OF SERVICES
Credential:
Phone: 970-250-5655