Provider Demographics
NPI:1801541792
Name:THE AGAPE ALLEN'S FOUNDATION II
Entity type:Organization
Organization Name:THE AGAPE ALLEN'S FOUNDATION II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR/TEACHER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARIAS
Authorized Official - Middle Name:ESAIAS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:TEACHER
Authorized Official - Phone:704-224-0895
Mailing Address - Street 1:4427 GREENRIDGE LN APT 22F
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-9132
Mailing Address - Country:US
Mailing Address - Phone:704-224-0895
Mailing Address - Fax:
Practice Address - Street 1:11530 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8460
Practice Address - Country:US
Practice Address - Phone:980-343-5988
Practice Address - Fax:980-343-5990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE AGAPE ALLEN'S FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child