1295876829 NPI number — AGAPE GROUP, INC.

Table of content: (NPI 1295876829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295876829 NPI number — AGAPE GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE GROUP, INC.
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 HOME HEALTHCARE
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:
1295876829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18770 LBJ FWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150-6407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-681-5959
Provider Business Mailing Address Fax Number:
972-681-8425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18770 LBJ FWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-681-5959
Provider Business Practice Location Address Fax Number:
972-681-8425
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANIEL
Authorized Official First Name:
SHAJI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-681-5959

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  004681 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000854100 . This is a "CBA CONTRACT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000034900 . This is a "PRIMARY CARE CONTRACT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 023914701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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