Provider Demographics
NPI:1841965571
Name:AGAPE HEALING COMMUNITY COORDINATION SERVICES LLC
Entity type:Organization
Organization Name:AGAPE HEALING COMMUNITY COORDINATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-467-3548
Mailing Address - Street 1:2601 WOODLAND PARK DR APT 7216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6172
Mailing Address - Country:US
Mailing Address - Phone:414-467-3548
Mailing Address - Fax:
Practice Address - Street 1:9431 W BELOIT RD STE 117
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4365
Practice Address - Country:US
Practice Address - Phone:414-467-3548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management