Provider Demographics
NPI:1215179015
Name:AGAPE
Entity type:Organization
Organization Name:AGAPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBUCKLE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:270-227-9924
Mailing Address - Street 1:96 JOBE LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL
Mailing Address - State:KY
Mailing Address - Zip Code:42049-8568
Mailing Address - Country:US
Mailing Address - Phone:270-227-9924
Mailing Address - Fax:
Practice Address - Street 1:96 JOBE LN
Practice Address - Street 2:
Practice Address - City:HAZEL
Practice Address - State:KY
Practice Address - Zip Code:42049-8568
Practice Address - Country:US
Practice Address - Phone:270-227-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities