Healthcare Provider Details

I. General information

NPI: 1679981278
Provider Name (Legal Business Name): AGAPE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 07/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MCLAWS CIR SUITE 2
WILLIAMSBURG VA
23185-6348
US

IV. Provider business mailing address

PO BOX 688
WILLIAMSBURG VA
23187-0688
US

V. Phone/Fax

Practice location:
  • Phone: 757-291-6016
  • Fax: 757-229-6185
Mailing address:
  • Phone: 757-291-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHCO-14809
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-14809
License Number StateVA

VIII. Authorized Official

Name: MR. BRAD FOORD
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 757-291-6016