MEDICARE: AGAPE COMMUNITY HEALTHCARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	135103	MO
2	253Z00000X	In Home Supportive Care Agency	135103	MO

General Provider Information

NPI Number	:	1154667947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COMMUNITY HEALTHCARE, P.C.

Provider Business Mailing Address
First Line	:	3004 S JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1513
Country	:	US
Telephone Number	:	314-775-8153
Fax Number	:	314-473-5615

Provider Business Practice Location Address
First Line	:	3004 S JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1513
Country	:	US
Telephone Number	:	314-775-8153
Fax Number	:	314-473-5615

Authorized Official
Title or Position	:	DIRECTOR/MANAGER
Name	:	MELONI ANN HUDDLESTON
Credential	:	RN, BSN
Telephone Number	:	314-637-6000

Provider Enumeration Date	:	12/24/2012
Last Update Date	:	10/29/2014

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