1467122556 NPI number — AGAPE CARE SERVICES OF FL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467122556 NPI number — AGAPE CARE SERVICES OF FL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE CARE SERVICES OF FL, LLC
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:
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:
1467122556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 N HOGAN ST STE 390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32202-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-962-0012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8110 LEM TURNER RD #2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-962-0012
Provider Business Practice Location Address Fax Number:
904-619-4933
Provider Enumeration Date:
09/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HENLEY
Authorized Official First Name:
AALIYAH
Authorized Official Middle Name:
NOISETTE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-962-0012

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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