Provider Demographics
NPI:1952717746
Name:AGAPE HOME CARE LLC
Entity type:Organization
Organization Name:AGAPE HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NON-MEDICAL CERTIFIED CARE GIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DIBERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-417-3501
Mailing Address - Street 1:3777 BROADRIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5439
Mailing Address - Country:US
Mailing Address - Phone:702-417-3507
Mailing Address - Fax:
Practice Address - Street 1:3777 BROADRIVER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5439
Practice Address - Country:US
Practice Address - Phone:702-417-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20141402790253Z00000X
NVG62-02365253Z00000X
NVC20140618-2996253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care