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General NPI Number Information
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NPI Number | 1346067436
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Entity Type | Organization
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Legal Business Name | AGAPE RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 1022 BLAIR FIELD LN
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City | FRESNO
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State | TX
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Zip | 77545-8689
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Country | US
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Telephone | 979-388-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 9444 CULLEN BLVD # 330282
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City | HOUSTON
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State | TX
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Zip | 77051-3384
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Country | US
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Telephone | 337-570-8647
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Fax |
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Authorized Official
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Title or Position | CEO/PROVIDER
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Name | MRS. OCTAVIA L KENNARD
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Credential |
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Telephone | 337-570-8647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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