Provider Demographics
NPI:1366181786
Name:AGAPE AWESOME ARRIVALS LLC
Entity type:Organization
Organization Name:AGAPE AWESOME ARRIVALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRANAISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-502-8636
Mailing Address - Street 1:6529 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4970
Mailing Address - Country:US
Mailing Address - Phone:414-502-8636
Mailing Address - Fax:
Practice Address - Street 1:6529 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4970
Practice Address - Country:US
Practice Address - Phone:414-502-8636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAPE HOME HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100042991Medicaid