Healthcare Provider Details

I. General information

NPI: 1891651543
Provider Name (Legal Business Name): AGAPE WAVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 PROSPECT AVE SUITE 2
KANSAS MO
64132
US

IV. Provider business mailing address

3519 CYPRESS AVE
KANSAS CITY MO
64128-2838
US

V. Phone/Fax

Practice location:
  • Phone: 816-214-3009
  • Fax:
Mailing address:
  • Phone: 816-214-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. AMRON JACKSON
Title or Position: OWNER
Credential:
Phone: 816-214-3009