MEDICARE: TSJ AGAPECARE INC.

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598181158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSJ AGAPECARE INC.

Provider Business Mailing Address
First Line	:	2866 WHIPPLE AVE NW UNIT 4
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1532
Country	:	US
Telephone Number	:	330-455-5440
Fax Number	:	330-455-5339

Provider Business Practice Location Address
First Line	:	2866 WHIPPLE AVE NW UNIT 4
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1532
Country	:	US
Telephone Number	:	330-455-5440
Fax Number	:	330-455-5339

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DAMEY HECKMAN
Credential	:	LPN
Telephone Number	:	330-455-5440

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	01/11/2024

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