Provider Demographics
NPI:1346067436
Name:AGAPE RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:AGAPE RESIDENTIAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-570-8647
Mailing Address - Street 1:9444 CULLEN BLVD # 330282
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-3384
Mailing Address - Country:US
Mailing Address - Phone:337-570-8647
Mailing Address - Fax:
Practice Address - Street 1:1022 BLAIR FIELD LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8689
Practice Address - Country:US
Practice Address - Phone:979-388-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home