Provider Demographics
NPI:1790456374
Name:AGAPE HOSPICE & PALLIATIVE CARE NW, LLC
Entity Type:Organization
Organization Name:AGAPE HOSPICE & PALLIATIVE CARE NW, LLC
Other - Org Name:AGAPE HOSPICE NW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:MIHAELA
Authorized Official - Last Name:LOUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-628-9595
Mailing Address - Street 1:10200 SW NIMBUS AVE STE G5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4339
Mailing Address - Country:US
Mailing Address - Phone:503-628-9595
Mailing Address - Fax:503-477-6547
Practice Address - Street 1:10200 SW NIMBUS AVE STE G5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4339
Practice Address - Country:US
Practice Address - Phone:503-746-4740
Practice Address - Fax:503-746-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16-1087Medicaid