Provider Demographics
NPI:1356000442
Name:AGAPE FREEDOM CARE CENTER
Entity Type:Organization
Organization Name:AGAPE FREEDOM CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHAQUITTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-334-7220
Mailing Address - Street 1:44107 W ROTH RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8473
Mailing Address - Country:US
Mailing Address - Phone:480-334-7220
Mailing Address - Fax:
Practice Address - Street 1:44107 W ROTH RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-8473
Practice Address - Country:US
Practice Address - Phone:480-334-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child