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General NPI Number Information
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NPI Number | 1215211149
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Entity Type | Organization
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Legal Business Name | AGAPE'S GRACE, INC.
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 2 S MULBERRY ST
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City | LOUISBURG
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State | KS
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Zip | 66053-6429
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Country | US
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Telephone | 913-837-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 34736 MISSION BELLEVIEW RD
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City | LOUISBURG
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State | KS
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Zip | 66053-6904
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Country | US
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Telephone | 913-526-2817
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Fax | 913-377-3316
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SUSAN RENAE JUAREZ
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Credential |
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Telephone | 913-526-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | KS
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