Provider Demographics
NPI:1689107567
Name:AGAPE IN MOTION
Entity Type:Organization
Organization Name:AGAPE IN MOTION
Other - Org Name:AIM INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-361-2727
Mailing Address - Street 1:PO BOX 300097
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-0366
Mailing Address - Country:US
Mailing Address - Phone:314-361-2727
Mailing Address - Fax:314-361-3070
Practice Address - Street 1:5227 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1027
Practice Address - Country:US
Practice Address - Phone:314-361-2727
Practice Address - Fax:314-361-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health