Provider Demographics
NPI:1013103951
Name:AGAPE II GHSD INC.
Entity Type:Organization
Organization Name:AGAPE II GHSD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HYESON
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM MANAGER
Authorized Official - Phone:910-980-1085
Mailing Address - Street 1:7279 SMITHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8315
Mailing Address - Country:US
Mailing Address - Phone:910-980-1085
Mailing Address - Fax:910-980-1768
Practice Address - Street 1:166 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-1382
Practice Address - Country:US
Practice Address - Phone:910-567-2869
Practice Address - Fax:910-980-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-070322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children