1568863157 NPI number — AGAPE HOSPICE & PALLIATIVE CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568863157 NPI number — AGAPE HOSPICE & PALLIATIVE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE HOSPICE & PALLIATIVE CARE, 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:
Provider Other Organization Name Type Code:
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:
1568863157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10200 SW NIMBUS AVE STE G5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIGARD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-914-7005
Provider Business Mailing Address Fax Number:
503-477-6547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3711 LOMITA BLVD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-234-5534
Provider Business Practice Location Address Fax Number:
213-234-5534
Provider Enumeration Date:
09/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LOUKA
Authorized Official First Name:
LARISA
Authorized Official Middle Name:
MIHAELA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
503-914-7005

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  550002355 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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