Healthcare Provider Details

I. General information

NPI: 1649549551
Provider Name (Legal Business Name): AGAPE HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8509 WESTERN HILLS BLVD SUITE 200
FORT WORTH TX
76108-3410
US

IV. Provider business mailing address

8509 WESTERN HILLS BLVD SUITE 200
FORT WORTH TX
76108-3410
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-4663
  • Fax: 817-336-5267
Mailing address:
  • Phone: 817-336-4663
  • Fax: 817-336-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number004346
License Number StateTX

VIII. Authorized Official

Name: MS. MICHELE ORSHAL
Title or Position: OWNER
Credential: R.N., C.M.C.
Phone: 817-336-4663