Healthcare Provider Details

I. General information

NPI: 1881876829
Provider Name (Legal Business Name): AGAPE FAMILY CARE HOMES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SE MAYNARD RD
CARY NC
27511-5718
US

IV. Provider business mailing address

PO BOX 14963
RALEIGH NC
27620-4963
US

V. Phone/Fax

Practice location:
  • Phone: 919-467-2416
  • Fax: 919-876-9252
Mailing address:
  • Phone: 919-467-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: EZUMA ASI
Title or Position: MANAGER
Credential:
Phone: 919-605-6177