Provider Demographics
NPI:1053077792
Name:AGAPE CARE SERVICES LLC
Entity Type:Organization
Organization Name:AGAPE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-451-4116
Mailing Address - Street 1:2505 CLUB PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8218
Mailing Address - Country:US
Mailing Address - Phone:954-451-4116
Mailing Address - Fax:
Practice Address - Street 1:2505 CLUB PL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8218
Practice Address - Country:US
Practice Address - Phone:954-451-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care