Provider Demographics
NPI:1245517630
Name:AGAPE HEALTH CARE LLC
Entity type:Organization
Organization Name:AGAPE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IZABELA
Authorized Official - Middle Name:MALGORZATA
Authorized Official - Last Name:FANEUF
Authorized Official - Suffix:
Authorized Official - Credentials:RN BBA
Authorized Official - Phone:978-633-4193
Mailing Address - Street 1:15 KING ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-1722
Mailing Address - Country:US
Mailing Address - Phone:978-633-4193
Mailing Address - Fax:978-633-4133
Practice Address - Street 1:15 KING ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1722
Practice Address - Country:US
Practice Address - Phone:978-633-4193
Practice Address - Fax:978-633-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266427311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility