=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346546561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAPE AFRICAN SENIOR SERVICES CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2011
-----------------------------------------------------
Last Update Date | 02/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 N 63RD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19139-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-667-1531
-----------------------------------------------------
Fax | 215-365-3205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 N 63RD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19139-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-667-1531
-----------------------------------------------------
Fax | 215-365-3205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JOHN K. JALLAH
-----------------------------------------------------
Credential | B.SC.
-----------------------------------------------------
Telephone | 215-667-1531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------