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General NPI Number Information
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NPI Number | 1477894095
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Entity Type | Organization
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Legal Business Name | AGAPE CONSUMER DIRECTED SERVICES, LLC
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 915 N TAYLOR AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2647
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Country | US
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Telephone | 314-568-8787
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Fax | 314-431-3002
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Provider Business Mailing Address
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Address Line | 10990 NEW HALLS FERRY RD SUITE J-#118
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City | SAINT LOUIS
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State | MO
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Zip | 63136-4497
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Country | US
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Telephone | 314-568-8787
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Fax | 314-431-3001
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CHERYL MORGAN YOUNG
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Credential |
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Telephone | 314-568-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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