Agape Home at Blueberry Fields Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL601304298 Issued in MI

Legal business name

AGAPE HOME AT BLUEBERRY FIELDS INC.

Practice address

4747 E Mt. Garfield Rd.
Fruitport, MI 49415

Phone

(231) 780-2229

Fax

(231) 780-9000

NPI assigned

Sep 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard Harold Ebeling

Title

President

Phone

(231) 780-2229

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1174873665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 LAKE FOREST LANE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "49441",
            "telephone_number": "231-780-2229",
            "fax_number": "231-780-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 E MT. GARFIELD RD.",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "49415",
            "telephone_number": "231-780-2229",
            "fax_number": "231-780-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE HOME AT BLUEBERRY FIELDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "EBELING",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-780-2229",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AL601304298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 640RX PLC
• Hannah Ellen Alveshere, DO
• Annette Book Bayne, L.M.S.W.
• Tammy Bonnier
• Sophia Spiros Bouyoucos-Sayen, RD
• Marissa Brandenburg, LPC

• All providers in Fruitport, MI
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.