Provider Demographics
NPI:1477197051
Name:AGAPE OF APPLETON, INC.
Entity Type:Organization
Organization Name:AGAPE OF APPLETON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:GIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-734-9871
Mailing Address - Street 1:7 TRI PARK WAY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1661
Mailing Address - Country:US
Mailing Address - Phone:920-734-9871
Mailing Address - Fax:920-734-0731
Practice Address - Street 1:7 TRI PARK WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1661
Practice Address - Country:US
Practice Address - Phone:920-734-9871
Practice Address - Fax:920-734-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care