Provider Demographics
NPI:1063867562
Name:AGAPE COTTAGE, INC.
Entity Type:Organization
Organization Name:AGAPE COTTAGE, INC.
Other - Org Name:AGAPE COTTAGE 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:U
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-394-8707
Mailing Address - Street 1:4931 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3004
Mailing Address - Country:US
Mailing Address - Phone:949-394-8707
Mailing Address - Fax:714-982-3433
Practice Address - Street 1:16192 CAIRO CIR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3001
Practice Address - Country:US
Practice Address - Phone:714-792-0967
Practice Address - Fax:714-982-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004348310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility