Provider Demographics
NPI:1023156569
Name:GHSD INC. (DBA) AGAPE GROUP HOMES
Entity type:Organization
Organization Name:GHSD INC. (DBA) AGAPE GROUP HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:REED
Authorized Official - Suffix:JR
Authorized Official - Credentials:RESIDENTIAL TECH
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 1:716 GREEN PATH RD
Practice Address - Street 2:
Practice Address - City:GODWIN
Practice Address - State:NC
Practice Address - Zip Code:28344-8918
Practice Address - Country:US
Practice Address - Phone:910-567-4340
Practice Address - Fax:910-980-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-052322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children