Provider Demographics
NPI:1770362196
Name:AGAPE FAMILY WOUND CARE LLC
Entity type:Organization
Organization Name:AGAPE FAMILY WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-983-6204
Mailing Address - Street 1:5800 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3021
Mailing Address - Country:US
Mailing Address - Phone:773-983-6204
Mailing Address - Fax:
Practice Address - Street 1:4001 W DEVON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4537
Practice Address - Country:US
Practice Address - Phone:773-983-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty