Provider Demographics
NPI:1295876829
Name:AGAPE GROUP, INC.
Entity type:Organization
Organization Name:AGAPE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAJI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-681-5959
Mailing Address - Street 1:18770 LBJ FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6407
Mailing Address - Country:US
Mailing Address - Phone:972-681-5959
Mailing Address - Fax:972-681-8425
Practice Address - Street 1:18770 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6407
Practice Address - Country:US
Practice Address - Phone:972-681-5959
Practice Address - Fax:972-681-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251X00000X
TX004681251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023914701Medicaid
TX000854100OtherCBA CONTRACT
TX000034900OtherPRIMARY CARE CONTRACT
TX000034900OtherPRIMARY CARE CONTRACT