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General NPI Number Information
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NPI Number | 1750772919
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Entity Type | Organization
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Legal Business Name | AGAPE FAMILY CARE HOME INC.
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 155 CARRIAGE LOOP
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City | BURLINGTON
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State | NC
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Zip | 27217-7549
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Country | US
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Telephone | 336-222-0135
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Fax | 336-222-8607
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Provider Business Mailing Address
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Address Line | PO BOX 5126
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City | BURLINGTON
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State | NC
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Zip | 27216-5126
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Country | US
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Telephone | 336-932-1593
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Fax | 336-222-8607
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MALTESE FULLER
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Credential |
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Telephone | 336-932-1593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-001-158
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License Number State | NC
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