Healthcare Provider Details

I. General information

NPI: 1477621878
Provider Name (Legal Business Name): AGAPE FAMILY CARE HOMES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 VIXEN CT
RALEIGH NC
27616-5284
US

IV. Provider business mailing address

PO BOX 14963 7208 VIXEN CT.
RALEIGH NC
27620-4963
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-5999
  • Fax: 919-876-9252
Mailing address:
  • Phone: 919-872-5999
  • Fax: 919-876-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC2274
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-520
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-539
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-622
License Number StateNC

VIII. Authorized Official

Name: MR. EZUMA ASI
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 919-605-6177