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General NPI Number Information
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NPI Number | 1942588587
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Entity Type | Organization
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Legal Business Name | AGAPE LIVING LLC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 1840 PHINIZY RD
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City | AUGUSTA
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State | GA
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Zip | 30906-5144
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Country | US
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Telephone | 706-993-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 PHINIZY RD
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City | AUGUSTA
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State | GA
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Zip | 30906-5144
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Country | US
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Telephone | 706-993-2188
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ELMIRA ELAINE ROULHAC
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Credential | RN
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Telephone | 706-306-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 359961093A
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License Number State | GA
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