1023156569 NPI number — GHSD INC. (DBA) AGAPE GROUP HOMES

Table of content: (NPI 1023156569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023156569 NPI number — GHSD INC. (DBA) AGAPE GROUP HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GHSD INC. (DBA) AGAPE GROUP HOMES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AGAPE GROUP HOMES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023156569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7279 SMITHFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GODWIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28344-8315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-980-1085
Provider Business Mailing Address Fax Number:
910-980-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 GREEN PATH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GODWIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28344-8918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-567-4340
Provider Business Practice Location Address Fax Number:
910-980-1768
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
ASSOCIATE PROFESSIONAL
Authorized Official Telephone Number:
910-980-1085

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-082-052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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