Healthcare Provider Details

I. General information

NPI: 1891027751
Provider Name (Legal Business Name): AGAPE COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 SUGAR PALM DR SUITE E
TAMPA FL
33619-1312
US

IV. Provider business mailing address

3802 SUGAR PALM DR SUITE E
TAMPA FL
33619-1312
US

V. Phone/Fax

Practice location:
  • Phone: 813-623-2422
  • Fax: 813-623-2419
Mailing address:
  • Phone: 813-623-2422
  • Fax: 813-623-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number692104396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number692104300
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number69214300
License Number StateFL

VIII. Authorized Official

Name: MRS. JANET LYNN GRADDY
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 813-623-2422