Healthcare Provider Details

I. General information

NPI: 1356971352
Provider Name (Legal Business Name): AGAPE ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2020
Last Update Date: 01/19/2020
Certification Date: 01/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 N RANCHO DR
LAS VEGAS NV
89130-3149
US

IV. Provider business mailing address

3650 N RANCHO DR STE 106
LAS VEGAS NV
89130-3151
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-1600
  • Fax:
Mailing address:
  • Phone:
  • 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: DENICIA POWELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-606-8535