Provider Demographics
NPI:1073752572
Name:AGAPE HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:AGAPE HEALTHCARE AGENCY, LLC
Other - Org Name:ALLIED COMMUNITY SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-5999
Mailing Address - Street 1:1307 E MILLBROOK RD
Mailing Address - Street 2:SUITE C-23
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5476
Mailing Address - Country:US
Mailing Address - Phone:919-872-5999
Mailing Address - Fax:
Practice Address - Street 1:1307 E MILLBROOK RD
Practice Address - Street 2:SUITE C-23
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5476
Practice Address - Country:US
Practice Address - Phone:919-872-5999
Practice Address - Fax:919-876-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health