Provider Demographics
NPI:1043415003
Name:AGAPE PLACE PERSONAL CARE HOMES INC
Entity Type:Organization
Organization Name:AGAPE PLACE PERSONAL CARE HOMES INC
Other - Org Name:AGAPE ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADM
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-941-9925
Mailing Address - Street 1:PO BOX 4026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-941-9925
Mailing Address - Fax:214-941-3822
Practice Address - Street 1:3107 W CAMP WISDOM RD STE 950
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2645
Practice Address - Country:US
Practice Address - Phone:214-941-9925
Practice Address - Fax:214-941-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012616OtherADULT DAY CARE
TX001012616OtherDADS CONTRACT NUMBER
TX001012616Medicaid