Provider Demographics
NPI:1790495554
Name:AGAPE HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:AGAPE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WANDAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-478-4752
Mailing Address - Street 1:4007 65TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2158
Mailing Address - Country:US
Mailing Address - Phone:612-387-6850
Mailing Address - Fax:
Practice Address - Street 1:5615 BLVD. STE 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2158
Practice Address - Country:US
Practice Address - Phone:763-297-3690
Practice Address - Fax:763-343-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health