Provider Demographics
NPI:1154568467
Name:AGAPE COMMUNITY LIVING, LLC
Entity type:Organization
Organization Name:AGAPE COMMUNITY LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:502-498-9713
Mailing Address - Street 1:8832 MOODY RD
Mailing Address - Street 2:#204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-5856
Mailing Address - Country:US
Mailing Address - Phone:502-608-6980
Mailing Address - Fax:502-742-3595
Practice Address - Street 1:8832 MOODY RD
Practice Address - Street 2:#204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5856
Practice Address - Country:US
Practice Address - Phone:502-608-6980
Practice Address - Fax:502-742-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health