Healthcare Provider Details

I. General information

NPI: 1407430820
Provider Name (Legal Business Name): AGAPE FAMILY HOME CARE BY E
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 CEDAR RUN CT NW
GRAND RAPIDS MI
49534-7962
US

IV. Provider business mailing address

986 CEDAR RUN CT NW
GRAND RAPIDS MI
49534-7962
US

V. Phone/Fax

Practice location:
  • Phone: 517-528-0829
  • Fax:
Mailing address:
  • Phone: 517-528-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ETOSSI HALL
Title or Position: CEO
Credential:
Phone: 517-528-0829