Provider Demographics
NPI:1477621878
Name:AGAPE FAMILY CARE HOMES, LLC.
Entity Type:Organization
Organization Name:AGAPE FAMILY CARE HOMES, LLC.
Other - Org Name:AGAPE HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-605-6177
Mailing Address - Street 1:PO BOX 14963
Mailing Address - Street 2:7208 VIXEN CT.
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4963
Mailing Address - Country:US
Mailing Address - Phone:919-872-5999
Mailing Address - Fax:919-876-9252
Practice Address - Street 1:7208 VIXEN CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5284
Practice Address - Country:US
Practice Address - Phone:919-872-5999
Practice Address - Fax:919-876-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2274251J00000X
NCMHL-092-5203104A0625X
NCMHL-092-5393104A0625X
NCMHL-092-6223104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251J00000XAgenciesNursing Care
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805229Medicaid
NC7804802Medicaid
NC7804684Medicaid