Healthcare Provider Details

I. General information

NPI: 1326423492
Provider Name (Legal Business Name): AGAPE ADULT DAY SERVICES AND RECREATIONAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SUNSET LOOP
GRENADA MS
38901-4429
US

IV. Provider business mailing address

PO BOX 2087
GRENADA MS
38902-2087
US

V. Phone/Fax

Practice location:
  • Phone: 662-307-2584
  • Fax:
Mailing address:
  • Phone: 662-307-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS ELIZABETH MICHELLE WOODS
Title or Position: OWNER/ADMINISTRATOR
Credential: LMSW
Phone: 662-719-6288