Healthcare Provider Details

I. General information

NPI: 1043136716
Provider Name (Legal Business Name): AGAPECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 LEE AVE N
BROOKLYN CENTER MN
55429-2476
US

IV. Provider business mailing address

10913 131ST AVE N
CHAMPLIN MN
55316-1143
US

V. Phone/Fax

Practice location:
  • Phone: 610-202-6770
  • Fax:
Mailing address:
  • Phone: 610-202-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PENNINAH OBWAYA
Title or Position: RN/BSN LALD
Credential:
Phone: 610-202-6770