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General NPI Number Information
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NPI Number | 1326568239
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Entity Type | Organization
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Legal Business Name | AGAPE HOME LIVING CARE, LLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2708 16TH STREET
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City | GREENSBORO
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State | NC
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Zip | 24239-4371
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Country | US
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Telephone | 336-324-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 16TH ST
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City | GREENSBORO
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State | NC
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Zip | 27405-4371
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Country | US
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Telephone | 336-324-8008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANTAY D PARKER
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Credential |
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Telephone | 336-324-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 041-1146
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License Number State | NC
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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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