MEDICARE: AGAPE PERSONAL CARE SERVICE LLC

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

General Provider Information

NPI Number	:	1720695026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE PERSONAL CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	1848 ERNEST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2359
Country	:	US
Telephone Number	:	317-494-5779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 ERNEST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2359
Country	:	US
Telephone Number	:	317-494-5779
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PRACTICAL NURSE
Name	:	MRS. RONNETTA HADEBE
Credential	:	LPN
Telephone Number	:	317-494-5779

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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