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General NPI Number Information
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NPI Number | 1871829010
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Entity Type | Organization
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Legal Business Name | AGAPE HERITAGE HOME INC
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 1911 GRAND WILLOW LN
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City | RICHMOND
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State | TX
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Zip | 77469-6344
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Country | US
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Telephone | 281-232-0648
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Fax | 281-239-0895
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Provider Business Mailing Address
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Address Line | 1911 GRAND WILLOW LN
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City | RICHMOND
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State | TX
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Zip | 77469-6344
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Country | US
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Telephone | 281-232-0648
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Fax | 281-239-0895
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DENNIS OSARUMWENSE
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Credential |
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Telephone | 713-562-5363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 102425
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 132667
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License Number State | TX
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