Healthcare Provider Details

I. General information

NPI: 1467122556
Provider Name (Legal Business Name): AGAPE CARE SERVICES OF FL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 06/07/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 LEM TURNER RD #2
JACKSONVILLE FL
32208
US

IV. Provider business mailing address

221 N HOGAN ST STE 390
JACKSONVILLE FL
32202-4201
US

V. Phone/Fax

Practice location:
  • Phone: 904-962-0012
  • Fax: 904-619-4933
Mailing address:
  • Phone: 904-962-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AALIYAH NOISETTE HENLEY
Title or Position: OWNER
Credential:
Phone: 904-962-0012