Provider Demographics
NPI:1639986870
Name:AGAPE LIFE AND HEALTH, LLC
Entity type:Organization
Organization Name:AGAPE LIFE AND HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHIPUE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP-BC, FNP-C
Authorized Official - Phone:718-607-1516
Mailing Address - Street 1:3534B AMBOY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2700
Mailing Address - Country:US
Mailing Address - Phone:718-607-1516
Mailing Address - Fax:
Practice Address - Street 1:3534B AMBOY RD SUITE 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2700
Practice Address - Country:US
Practice Address - Phone:718-607-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty