Provider Demographics
NPI:1871829010
Name:AGAPE HERITAGE HOME INC
Entity Type:Organization
Organization Name:AGAPE HERITAGE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSARUMWENSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-562-5363
Mailing Address - Street 1:1911 GRAND WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6344
Mailing Address - Country:US
Mailing Address - Phone:281-232-0648
Mailing Address - Fax:281-239-0895
Practice Address - Street 1:1911 GRAND WILLOW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6344
Practice Address - Country:US
Practice Address - Phone:281-232-0648
Practice Address - Fax:281-239-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132667310400000X
TX102425311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)