Provider Demographics
NPI:1558799106
Name:AGAPE HOME CARE
Entity Type:Organization
Organization Name:AGAPE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIDIST
Authorized Official - Middle Name:TAYE
Authorized Official - Last Name:GEMTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-384-6513
Mailing Address - Street 1:PO BOX 6813
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-0813
Mailing Address - Country:US
Mailing Address - Phone:612-384-6513
Mailing Address - Fax:612-584-4934
Practice Address - Street 1:2327 E FRANKLIN AVE.
Practice Address - Street 2:SUITE #3
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-384-6513
Practice Address - Fax:612-584-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health