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General NPI Number Information
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NPI Number | 1497258107
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Entity Type | Organization
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Legal Business Name | AGAPE ESSENTIAL INC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 2141 BERTHA ST
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City | KANNAPOLIS
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State | NC
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Zip | 28083-3023
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Country | US
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Telephone | 704-298-2433
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Fax | 773-337-9740
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Provider Business Mailing Address
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Address Line | PO BOX 563304
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City | CHARLOTTE
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State | NC
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Zip | 28256-3304
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Country | US
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Telephone | 704-298-2433
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Fax | 704-973-9134
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Authorized Official
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Title or Position | CEO
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Name | TRENITA CROUCH
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Credential | MA
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Telephone | 704-298-2433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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