Healthcare Provider Details

I. General information

NPI: 1629247614
Provider Name (Legal Business Name): AGAPE HEALTH MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 LINCOLNIA RD
ALEXANDRIA VA
22312-1533
US

IV. Provider business mailing address

6349 LINCOLNIA RD
ALEXANDRIA VA
22312-1533
US

V. Phone/Fax

Practice location:
  • Phone: 703-354-6767
  • Fax: 703-354-2323
Mailing address:
  • Phone: 703-354-6767
  • Fax: 703-354-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberFX.08-051-L155
License Number StateVA

VIII. Authorized Official

Name: DONG CHUL CHOI
Title or Position: PRESIDENT
Credential:
Phone: 703-354-6767