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General NPI Number Information
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NPI Number | 1427486182
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Entity Type | Organization
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Legal Business Name | AGAPE LIVING LLC
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 1840 PHINIZY RD
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City | AUGUSTA
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State | GA
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Zip | 30906-5144
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Country | US
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Telephone | 706-993-2188
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Fax | 706-993-2188
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Provider Business Mailing Address
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Address Line | 1840 PHINIZY RD
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City | AUGUSTA
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State | GA
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Zip | 30906-5144
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Country | US
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Telephone | 706-993-2188
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Fax | 706-993-2188
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Authorized Official
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Title or Position | RN
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Name | MRS. ELMIRA ELAINE ROUHAC
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Credential | ADMINISTRATOR
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Telephone | 706-306-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 121-03-020-1
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License Number State | GA
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