1679826549 NPI number — AGAPE HOSPICE & PALLIATIVE CARE, LLC

Table of content: (NPI 1679826549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679826549 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:
1679826549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5211 N SALIDA DEL SOL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-5411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-615-4751
Provider Business Mailing Address Fax Number:
520-577-0863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 N SWAN ROAD
Provider Second Line Business Practice Location Address:
SUITE 227
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-664-8624
Provider Business Practice Location Address Fax Number:
520-615-7802
Provider Enumeration Date:
10/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARTZ
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
520-260-0937

Provider Taxonomy Codes

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

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





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