Healthcare Provider Details

I. General information

NPI: 1770353435
Provider Name (Legal Business Name): AGAPE DAY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 PHINIZY RD
AUGUSTA GA
30906-5144
US

IV. Provider business mailing address

3856 WOODLAKE DR
HEPHZIBAH GA
30815-6009
US

V. Phone/Fax

Practice location:
  • Phone: 706-993-2188
  • Fax: 706-993-2188
Mailing address:
  • Phone: 706-306-1157
  • Fax: 706-993-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELMIRA G ROULHAC
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 706-306-1157