Healthcare Provider Details

I. General information

NPI: 1912142399
Provider Name (Legal Business Name): THE AGAPE HOUSE OF LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11406 RICHMOND DR
KANSAS CITY MO
64134-3551
US

IV. Provider business mailing address

11406 RICHMOND DR
KANSAS CITY MO
64134-3551
US

V. Phone/Fax

Practice location:
  • Phone: 816-728-3924
  • Fax:
Mailing address:
  • Phone: 816-728-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberG213223032
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberG213223032
License Number StateMO

VIII. Authorized Official

Name: MRS. OZANNA OBASI
Title or Position: DIRECTOR
Credential:
Phone: 816-728-3924