Healthcare Provider Details
I. General information
NPI: 1528506086
Provider Name (Legal Business Name): AGAPE FAMILY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/05/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2604 JOHNSON RD
UPPER CHICHESTER PA
19061-3523
US
IV. Provider business mailing address
2604 JOHNSON RD
UPPER CHICHESTER PA
19061-3523
US
V. Phone/Fax
- Phone: 267-408-2202
- Fax:
- Phone: 267-408-2202
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | 103027299 |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0100X |
| Taxonomy | Gastroenterology Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0600X |
| Taxonomy | Gerontology Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0600X |
| Taxonomy | Infection Control Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0705X |
| Taxonomy | Medical-Surgical Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX1500X |
| Taxonomy | Ostomy Care Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR0400X |
| Taxonomy | Rehabilitation Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 103027299 |
| License Number State | PA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 164W00000X |
| Taxonomy | Licensed Practical Nurse |
| License Number | 103027299 |
| License Number State | PA |
VIII. Authorized Official
Name:
RACHEAL
CHRISTIANA
BUNDOR
Title or Position: OWNER
Credential: LPN
Phone: 267-408-2202
