Provider Demographics
NPI:1639634512
Name:AGAPE LOVE INTERNATIONAL FOUNDATION, INC
Entity Type:Organization
Organization Name:AGAPE LOVE INTERNATIONAL FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSHA
Authorized Official - Middle Name:DETREESE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-254-4665
Mailing Address - Street 1:736 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5041
Mailing Address - Country:US
Mailing Address - Phone:346-254-4665
Mailing Address - Fax:346-345-2543
Practice Address - Street 1:736 WILSON RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5041
Practice Address - Country:US
Practice Address - Phone:354-254-4665
Practice Address - Fax:346-345-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of Service