Healthcare Provider Details

I. General information

NPI: 1841862299
Provider Name (Legal Business Name): AGAPE LIFE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 NORTHBROOK DR
CHARLOTTE NC
28216-3777
US

IV. Provider business mailing address

1633 NORTHBROOK DR
CHARLOTTE NC
28216-3777
US

V. Phone/Fax

Practice location:
  • Phone: 704-548-0567
  • Fax:
Mailing address:
  • Phone: 704-548-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: QUANITA HENDERSON
Title or Position: OWNER
Credential:
Phone: 704-548-0567