1477621878 NPI number — AGAPE FAMILY CARE HOMES, LLC.

Table of content: MRS. KIRSTEN BILLING ADAMSON PAA (NPI 1194976191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477621878 NPI number — AGAPE FAMILY CARE HOMES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE FAMILY CARE HOMES, LLC.
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 HEALTHCARE SERVICES
Provider Other Organization Name Type Code:
5
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:
1477621878
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:
PO BOX 14963
Provider Second Line Business Mailing Address:
7208 VIXEN CT.
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27620-4963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-872-5999
Provider Business Mailing Address Fax Number:
919-876-9252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7208 VIXEN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27616-5284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-872-5999
Provider Business Practice Location Address Fax Number:
919-876-9252
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASI
Authorized Official First Name:
EZUMA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-605-6177

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  HC2274 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3104A0625X , with the licence number: MHL-092-520 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3104A0625X , with the licence number: MHL-092-539 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3104A0625X , with the licence number: MHL-092-622 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 7805229 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804802 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804684 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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