MEDICARE: AGAPE LOVE HOMECARE & MIHP,INC

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	251K00000X	Public Health or Welfare Agency		MI

General Provider Information

NPI Number	:	1124308960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE LOVE HOMECARE & MIHP,INC

Provider Business Mailing Address
First Line	:	1230 COOLIDGE HWY
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1478
Country	:	US
Telephone Number	:	313-778-9632
Fax Number	:	734-629-8287

Provider Business Practice Location Address
First Line	:	1230 COOLIDGE HWY
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1478
Country	:	US
Telephone Number	:	313-778-9632
Fax Number	:	734-629-8287

Authorized Official
Title or Position	:	CEO
Name	:	ROBIN HAILEY
Credential	:
Telephone Number	:	313-778-9632

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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