Provider Demographics
NPI:1255672184
Name:HOUSE OF AGAPE
Entity Type:Organization
Organization Name:HOUSE OF AGAPE
Other - Org Name:ELAINE WILLIAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-869-5804
Mailing Address - Street 1:278 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3014
Mailing Address - Country:US
Mailing Address - Phone:234-466-7662
Mailing Address - Fax:234-466-0055
Practice Address - Street 1:278 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3014
Practice Address - Country:US
Practice Address - Phone:234-466-7662
Practice Address - Fax:234-466-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF AGAPE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-01
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency