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General NPI Number Information
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NPI Number | 1952634503
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Entity Type | Organization
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Legal Business Name | AGAPE ADHC DBA AGAPE CONSUMER DIRECT SERVICES
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 915 N TAYLOR AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2647
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Country | US
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Telephone | 314-581-2252
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Fax | 314-431-3001
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Provider Business Mailing Address
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Address Line | 11220 W FLORISSANT AVE # 118
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City | FLORISSANT
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State | MO
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Zip | 63033-6741
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Country | US
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Telephone | 314-581-2252
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Fax | 314-431-3001
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLIFFORD VERNON YOUNG
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Credential |
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Telephone | 314-581-2252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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