Provider Demographics
NPI:1659516235
Name:AGAPEWELLNESS GOLDEN SOUTIONS
Entity Type:Organization
Organization Name:AGAPEWELLNESS GOLDEN SOUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELDERCARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:WHITE-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-271-4093
Mailing Address - Street 1:3425 CARLY DR
Mailing Address - Street 2:4325 CARLY DR
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2541
Mailing Address - Country:US
Mailing Address - Phone:209-271-4093
Mailing Address - Fax:209-946-0592
Practice Address - Street 1:3425 CARLY DR
Practice Address - Street 2:3425 CARLY DR
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2541
Practice Address - Country:US
Practice Address - Phone:209-271-4093
Practice Address - Fax:209-946-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service