Organization
AGAPE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELMIRA ELAINE ROULHAC RN (ADMINISTRATOR)
(706) 306-1157
Entity
Organization
Contact information
Practice address
1840 PHINIZY RD, AUGUSTA, GA 30906-5144
(706) 993-2188
Mailing address
1840 PHINIZY RD, AUGUSTA, GA 30906-5144
(706) 993-2188
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
359961093A
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
359961093A
DEPARTMENT OF COMMUNITY HEALTH
GA
Enumeration date
08/01/2011
Last updated
08/01/2011
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