Provider Demographics
NPI:1679981278
Name:AGAPE HOME CARE LLC
Entity type:Organization
Organization Name:AGAPE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-291-6016
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23187-0688
Mailing Address - Country:US
Mailing Address - Phone:757-291-6016
Mailing Address - Fax:
Practice Address - Street 1:350 MCLAWS CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6348
Practice Address - Country:US
Practice Address - Phone:757-291-6016
Practice Address - Fax:757-229-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-14809251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0153531394Medicaid
VA0165327625Medicaid
VA0153531980Medicaid