MEDICARE: AGAPE CHILD PLACEMENT AGENCY INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253J00000X	Foster Care Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	101Y00000X	Counselor
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	2084P0800X	Psychiatry Physician
6	251B00000X	Case Management Agency
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1639640618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE CHILD PLACEMENT AGENCY INC.

Provider Business Mailing Address
First Line	:	PO BOX 3319
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28111-3319
Country	:	US
Telephone Number	:	704-291-7879
Fax Number	:	855-518-5592

Provider Business Practice Location Address
First Line	:	717 E PARK DR
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-5045
Country	:	US
Telephone Number	:	704-291-7879
Fax Number	:	855-518-5592

Authorized Official
Title or Position	:	COO
Name	:	MRS. WHITNEY JANENE HINTON
Credential	:	QP
Telephone Number	:	704-291-7879

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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