Provider Demographics
NPI:1922440189
Name:AGAPE FAMILY CARE HOMES, LLC.
Entity Type:Organization
Organization Name:AGAPE FAMILY CARE HOMES, LLC.
Other - Org Name:AGAPE FAMILY CARE HOME #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-605-6177
Mailing Address - Street 1:PO BOX 14963
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4963
Mailing Address - Country:US
Mailing Address - Phone:919-605-6177
Mailing Address - Fax:919-876-9252
Practice Address - Street 1:5024 DANTREE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5351
Practice Address - Country:US
Practice Address - Phone:919-605-6177
Practice Address - Fax:919-876-9252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAPE FAMILY CARE HOMES, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-29
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
NCFCL-092-1843104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL-092-184OtherDHSR