MEDICARE: AGAPE HEALTHCARE AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1073752572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE HEALTHCARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	1307 E MILLBROOK RD
Second Line	:	SUITE C-23
City	:	RALEIGH
State	:	NC
Zip	:	27609-5476
Country	:	US
Telephone Number	:	919-872-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 E MILLBROOK RD
Second Line	:	SUITE C-23
City	:	RALEIGH
State	:	NC
Zip	:	27609-5476
Country	:	US
Telephone Number	:	919-872-5999
Fax Number	:	919-876-9252

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EZUMA ASI
Credential	:
Telephone Number	:	919-872-5999

Provider Enumeration Date	:	02/07/2009
Last Update Date	:	02/07/2009

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