Provider Demographics
NPI:1679940555
Name:AGAPE' ADULT DAY CARE HOME, LLC
Entity Type:Organization
Organization Name:AGAPE' ADULT DAY CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-532-9837
Mailing Address - Street 1:1307 HAZELNUT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4933
Mailing Address - Country:US
Mailing Address - Phone:919-532-9837
Mailing Address - Fax:844-279-1837
Practice Address - Street 1:412 S GRACE ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5815
Practice Address - Country:US
Practice Address - Phone:252-443-5343
Practice Address - Fax:844-279-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility