Provider Demographics
NPI:1205967403
Name:AGAPE CARE LLC
Entity type:Organization
Organization Name:AGAPE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-250-5655
Mailing Address - Street 1:54783 ME RD
Mailing Address - Street 2:
Mailing Address - City:COLLBRAN
Mailing Address - State:CO
Mailing Address - Zip Code:81624-9722
Mailing Address - Country:US
Mailing Address - Phone:970-250-5655
Mailing Address - Fax:970-487-3231
Practice Address - Street 1:54783 ME RD
Practice Address - Street 2:
Practice Address - City:COLLBRAN
Practice Address - State:CO
Practice Address - Zip Code:81624-9722
Practice Address - Country:US
Practice Address - Phone:970-250-5655
Practice Address - Fax:970-487-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10H563251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63081750Medicaid