Provider Demographics
NPI:1770277964
Name:AGAPE HOMECARE LLC
Entity type:Organization
Organization Name:AGAPE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KWAMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:701-929-0201
Mailing Address - Street 1:875 34TH AVE E APT 309
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8051
Mailing Address - Country:US
Mailing Address - Phone:701-929-0201
Mailing Address - Fax:
Practice Address - Street 1:2429 W COUNTRY CLUB DR S APT 8
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5746
Practice Address - Country:US
Practice Address - Phone:701-929-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care