Provider Demographics
NPI:1659680593
Name:AGAPE CARE SERVICES, INC,
Entity Type:Organization
Organization Name:AGAPE CARE SERVICES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-474-3213
Mailing Address - Street 1:34 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3126
Mailing Address - Country:US
Mailing Address - Phone:440-428-0056
Mailing Address - Fax:440-428-0079
Practice Address - Street 1:34 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3126
Practice Address - Country:US
Practice Address - Phone:440-428-0056
Practice Address - Fax:440-428-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4301786251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4301786Medicaid