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General NPI Number Information
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NPI Number | 1952717746
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Entity Type | Organization
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Legal Business Name | AGAPE HOME CARE LLC
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 3777 BROADRIVER DR
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City | LAS VEGAS
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State | NV
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Zip | 89108-5439
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Country | US
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Telephone | 702-417-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 3777 BROADRIVER DR
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City | LAS VEGAS
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State | NV
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Zip | 89108-5439
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Country | US
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Telephone | 702-417-3507
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Fax |
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Authorized Official
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Title or Position | NON-MEDICAL CERTIFIED CARE GIVER
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Name | MRS. LISA MARIE DIBERNARDO
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Credential |
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Telephone | 702-417-3501
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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 | 20141402790
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License Number State | NV
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