Healthcare Provider Details

I. General information

NPI: 1376178814
Provider Name (Legal Business Name): AGAPE COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 DUNN AVE STE 34-37
JACKSONVILLE FL
32218-4782
US

IV. Provider business mailing address

1680 DUNN AVE STE 34-37
JACKSONVILLE FL
32218-4782
US

V. Phone/Fax

Practice location:
  • Phone: 904-760-4904
  • Fax:
Mailing address:
  • Phone: 904-760-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHENITA SMITH
Title or Position: BUSINESS COORDINATOR
Credential:
Phone: 904-800-6347