Healthcare Provider Details

I. General information

NPI: 1114139870
Provider Name (Legal Business Name): AGAPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16046 W 343RD ST
PAOLA KS
66071
US

IV. Provider business mailing address

34850 MISSION BELLVIEW
LOUISBURG KS
66053
US

V. Phone/Fax

Practice location:
  • Phone: 913-526-2817
  • Fax:
Mailing address:
  • Phone: 913-526-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateKS

VIII. Authorized Official

Name: MRS. SUSAN RENAE JUAREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 913-526-2817