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General NPI Number Information
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NPI Number | 1235580150
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Entity Type | Organization
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Legal Business Name | AGAPE COTTAGE, INC.
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 19982 AVENIDA PUESTA DEL SOL
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City | YORBA LINDA
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State | CA
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Zip | 92886-2908
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Country | US
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Telephone | 949-394-8707
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Fax | 714-982-3433
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Provider Business Mailing Address
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Address Line | 4931 CARTHAGE ST
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City | PLACENTIA
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State | CA
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Zip | 92870-3004
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Country | US
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Telephone | 949-394-8707
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Fax | 714-982-3433
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPH ALVAREZ
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Credential |
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Telephone | 949-394-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 306004664
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License Number State | CA
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