Healthcare Provider Details

I. General information

NPI: 1053469064
Provider Name (Legal Business Name): AGAPE HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S HERLONG AVE
ROCK HILL SC
29732-1100
US

IV. Provider business mailing address

127 S HERLONG AVE
ROCK HILL SC
29732-1100
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-2324
  • Fax: 803-366-2388
Mailing address:
  • Phone: 803-366-2324
  • Fax: 803-366-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DANIEL R HUTTO JR.
Title or Position: DIRECTOR
Credential:
Phone: 803-939-0757