=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023210184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINDS OF AGAPE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 GRANT BLVD
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13208-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-0547
-----------------------------------------------------
Fax | 315-295-0264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 GRANT BLVD
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13208-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-0547
-----------------------------------------------------
Fax | 315-295-0264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LAVERNE TORRENCE
-----------------------------------------------------
Credential | RN, MSN
-----------------------------------------------------
Telephone | 315-425-0547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1090L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------