1215840426 NPI number — AGAPE MEDICAL SERVICES PA

Table of content: (NPI 1215840426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215840426 NPI number — AGAPE MEDICAL SERVICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE MEDICAL SERVICES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215840426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 N BROADWAY STE 32260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90012-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-607-8781
Provider Business Mailing Address Fax Number:
323-524-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 W 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-607-8781
Provider Business Practice Location Address Fax Number:
323-524-1691
Provider Enumeration Date:
09/28/2026

Additional Information

Authorized Official

Authorized Official Last Name:
RENGER
Authorized Official First Name:
BAILEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
323-607-8781

Provider Taxonomy Codes

  • Taxonomy code: 2085U0001X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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