Provider Demographics
NPI:1487367223
Name:AGAPE RESIDENTIAL CARE
Entity type:Organization
Organization Name:AGAPE RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-372-1149
Mailing Address - Street 1:5141 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1220
Mailing Address - Country:US
Mailing Address - Phone:757-372-1149
Mailing Address - Fax:
Practice Address - Street 1:934 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-5628
Practice Address - Country:US
Practice Address - Phone:757-372-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty