=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801541792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE AGAPE ALLEN'S FOUNDATION II
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11530 BEATTIES FORD RD
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-8460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-343-5988
-----------------------------------------------------
Fax | 980-343-5990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4427 GREENRIDGE LN APT 22F
-----------------------------------------------------
City | KANNAPOLIS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28081-9132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-224-0895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PASTOR/TEACHER
-----------------------------------------------------
Name | MR. ZACHARIAS ESAIAS ALLEN SR.
-----------------------------------------------------
Credential | TEACHER
-----------------------------------------------------
Telephone | 704-224-0895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385HR2055X
-----------------------------------------------------
Taxonomy Name | Child Mental Illness Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------