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General NPI Number Information
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NPI Number | 1134960958
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Entity Type | Organization
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Legal Business Name | AGAPE INDEPENDENT LIVING GROUP LLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 830 GRACERN RD
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City | COLUMBIA
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State | SC
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Zip | 29210-7629
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Country | US
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Telephone | 706-842-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 209 7TH ST FL 5
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City | AUGUSTA
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State | GA
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Zip | 30901-1484
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Country | US
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Telephone | 706-842-5330
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ALLAN J SOTO
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Credential |
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Telephone | 706-399-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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