Provider Demographics
NPI:1881876829
Name:AGAPE FAMILY CARE HOMES, LLC.
Entity type:Organization
Organization Name:AGAPE FAMILY CARE HOMES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-605-6177
Mailing Address - Street 1:PO BOX 14963
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4963
Mailing Address - Country:US
Mailing Address - Phone:919-467-2416
Mailing Address - Fax:
Practice Address - Street 1:604 SE MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5718
Practice Address - Country:US
Practice Address - Phone:919-467-2416
Practice Address - Fax:919-876-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385HR2060X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child