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General NPI Number Information
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NPI Number | 1588366322
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Entity Type | Organization
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Legal Business Name | AGAPE HOUSE, LLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 613 CARLTON DR
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City | HAMPTON
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State | VA
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Zip | 23666-2915
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Country | US
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Telephone | 202-465-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 613 CARLTON DR
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City | HAMPTON
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State | VA
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Zip | 23666-2915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANGELICA FIELDS
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Credential |
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Telephone | 202-465-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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