Provider Demographics
NPI:1790664514
Name:AGAPE LIVING LLC
Entity type:Organization
Organization Name:AGAPE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREJE
Authorized Official - Middle Name:ASSEBOT
Authorized Official - Last Name:ABEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, BSN, RN, DN
Authorized Official - Phone:443-320-3284
Mailing Address - Street 1:1300 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1106
Mailing Address - Country:US
Mailing Address - Phone:443-320-3284
Mailing Address - Fax:
Practice Address - Street 1:1300 CRESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1106
Practice Address - Country:US
Practice Address - Phone:301-328-0085
Practice Address - Fax:240-885-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility