Provider Demographics
NPI:1437753670
Name:AGAPE CARE FAMILY HOME
Entity type:Organization
Organization Name:AGAPE CARE FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-686-5841
Mailing Address - Street 1:626 WIGEON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8380
Mailing Address - Country:US
Mailing Address - Phone:336-686-5841
Mailing Address - Fax:336-579-0510
Practice Address - Street 1:5767 NC HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-8477
Practice Address - Country:US
Practice Address - Phone:336-686-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-29
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437753670Medicaid