Organization
AGAPE COMMUNITY LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL VIBBERT RN, BSN (EXECUTIVE DIRECTOR)
(502) 749-3257
Entity
Organization
Contact information
Practice address
4200 WALLINGFORD LN, LOUISVILLE, KY 40218-2720
(502) 749-3257
(502) 742-3141
Mailing address
4200 WALLINGFORD LN, LOUISVILLE, KY 40218-2720
(502) 749-3257
(502) 742-3141
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
251S00000X
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154568467
—
KY
Enumeration date
07/09/2012
Last updated
07/09/2012
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