1699895540 NPI number — AGAPE FAMILY CARE HOMES, LLC

Table of content: (NPI 1699895540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699895540 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:
Provider Other Organization Name Type Code:
6
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:
1699895540
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:
2336 RAVENHILL DR
Provider Second Line Business Mailing Address:
PO BOX 14963
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-7531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-790-1016
Provider Business Mailing Address Fax Number:
919-876-9252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2336 RAVENHILL DR
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:
27615-7531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-790-1016
Provider Business Practice Location Address Fax Number:
919-876-9252
Provider Enumeration Date:
04/01/2007

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: 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: "Y" .

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

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




Copyright © 2007-2025 www.npivalidator.com