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General NPI Number Information
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NPI Number | 1275895419
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Entity Type | Organization
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Legal Business Name | AGAPE HOSPICE CARE OF CAROLLTON, LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 126 W MONTGOMERY ST
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City | VILLA RICA
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State | GA
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Zip | 30180-2734
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Country | US
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Telephone | 404-763-1456
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Fax | 404-343-4783
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Provider Business Mailing Address
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Address Line | 717 N HARWOOD ST STE 550
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City | DALLAS
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State | TX
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Zip | 75201-6540
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Country | US
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Telephone |
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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 | ANDREA BOHANNON
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Credential |
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Telephone | 214-628-9951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | GA
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