Provider Demographics
NPI:1407227838
Name:AGAPE LOVE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:AGAPE LOVE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-322-1557
Mailing Address - Street 1:1628 EMERALD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2046
Mailing Address - Country:US
Mailing Address - Phone:314-322-1557
Mailing Address - Fax:
Practice Address - Street 1:1628 EMERALD CREEK DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2046
Practice Address - Country:US
Practice Address - Phone:314-322-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLC001428754OtherSTATE OF MISSOURI CHARTER NUMBER