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General NPI Number Information
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NPI Number | 1497554943
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Entity Type | Organization
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Legal Business Name | AGAPE WAVE LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 6840 PROSPECT AVE
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City | KANSAS CITY
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State | MO
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Zip | 64132-1302
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Country | US
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Telephone | 816-214-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 3519 CYPRESS AVE
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City | KANSAS CITY
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State | MO
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Zip | 64128-2838
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Country | US
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Telephone | 816-214-3009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AMRON W JACKSON
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Credential |
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Telephone | 816-214-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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