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General NPI Number Information
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NPI Number | 1053555607
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Entity Type | Organization
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Legal Business Name | GENUINE AGAPE CARE
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 15802 LESURE ST
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City | DETROIT
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State | MI
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Zip | 48227-3336
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Country | US
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Telephone | 877-526-3186
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Fax |
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Provider Business Mailing Address
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Address Line | 15802 LESURE ST
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City | DETROIT
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State | MI
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Zip | 48227-3336
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Country | US
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Telephone | 877-526-3186
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MRS. WILLIE JOYCE JOHNSON
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Credential | NURSING ASSISTANT
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Telephone | 877-526-3186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 230002612990406
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License Number State | MI
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