Provider Demographics
NPI:1134443351
Name:AGAPE SERVICES INC
Entity type:Organization
Organization Name:AGAPE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-225-0584
Mailing Address - Street 1:806 CIRCLE DR
Mailing Address - Street 2:PO BOX 3319
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-3800
Mailing Address - Country:US
Mailing Address - Phone:704-225-0584
Mailing Address - Fax:704-225-1479
Practice Address - Street 1:806 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-3800
Practice Address - Country:US
Practice Address - Phone:704-225-0584
Practice Address - Fax:704-225-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5901922261Q00000X
NC5212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005849Medicaid
NC5916011Medicaid