=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710551775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAPE FAMILY CARE HOMES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2021
-----------------------------------------------------
Last Update Date | 05/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 WALNUT ST
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-4733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-605-6177
-----------------------------------------------------
Fax | 919-876-9252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14963
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27620-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-605-6177
-----------------------------------------------------
Fax | 919-876-9252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JANE ASI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-605-6177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------