Healthcare Provider Details

I. General information

NPI: 1598987455
Provider Name (Legal Business Name): AGAPE HOSPICE CARE OF RUSTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 GOODWIN RD SUITE 101
RUSTON LA
71270-2948
US

IV. Provider business mailing address

1503 GOODWIN RD SUITE 101
RUSTON LA
71270-2948
US

V. Phone/Fax

Practice location:
  • Phone: 318-513-1112
  • Fax:
Mailing address:
  • Phone: 318-513-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN C GAMBLE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-798-2648