1023305208 NPI number — AGAPE SERVICES INC

Table of content: (NPI 1023305208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023305208 NPI number — AGAPE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE SERVICES 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:
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:
1023305208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3319
Provider Second Line Business Mailing Address:
806 CIRCLE DRIVE
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28111-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-225-0584
Provider Business Mailing Address Fax Number:
800-755-9281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 CIRCLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-225-0584
Provider Business Practice Location Address Fax Number:
800-755-9281
Provider Enumeration Date:
07/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MASSEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JEFFERY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-225-0584

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6008247 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303172 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303351 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303350 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5916011 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301179 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603310 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603506 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603913 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6604025 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com