Provider Demographics
NPI:1609921691
Name:AGAPE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:AGAPE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-696-1350
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3277
Mailing Address - Country:US
Mailing Address - Phone:847-696-1350
Mailing Address - Fax:847-696-1370
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3277
Practice Address - Country:US
Practice Address - Phone:847-696-1350
Practice Address - Fax:847-696-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011763251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147992OtherMEDICARE PROVIDER