Provider Demographics
NPI:1407413826
Name:AGAPE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:AGAPE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-877-8599
Mailing Address - Street 1:32980 WEBBER RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2328
Mailing Address - Country:US
Mailing Address - Phone:305-877-8599
Mailing Address - Fax:
Practice Address - Street 1:4000 SENECA AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2631
Practice Address - Country:US
Practice Address - Phone:305-877-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health