Provider Demographics
NPI:1083432322
Name:AGAPE PLACE HEALTHCARE
Entity type:Organization
Organization Name:AGAPE PLACE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:214-282-1761
Mailing Address - Street 1:1706 EDGEVIEW
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0448
Mailing Address - Country:US
Mailing Address - Phone:214-282-1761
Mailing Address - Fax:
Practice Address - Street 1:1706 EDGEVIEW
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-0448
Practice Address - Country:US
Practice Address - Phone:214-282-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health