Provider Demographics
NPI:1275895419
Name:AGAPE HOSPICE CARE OF CAROLLTON, LLC
Entity Type:Organization
Organization Name:AGAPE HOSPICE CARE OF CAROLLTON, LLC
Other - Org Name:AGAPE HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRODDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-763-1456
Mailing Address - Street 1:5715 BROOKSTONE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2734
Practice Address - Country:US
Practice Address - Phone:404-763-1456
Practice Address - Fax:404-343-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based