Provider Demographics
NPI:1639308273
Name:AGAPE PERFECT CARE LLC
Entity Type:Organization
Organization Name:AGAPE PERFECT CARE LLC
Other - Org Name:AGAPE PERFECT CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:HICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-715-9030
Mailing Address - Street 1:2609 JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2242
Mailing Address - Country:US
Mailing Address - Phone:817-715-9030
Mailing Address - Fax:
Practice Address - Street 1:2609 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2242
Practice Address - Country:US
Practice Address - Phone:817-715-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-03
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child