=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124818026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAPE WOUND CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9556 PARK MEADOWS DR STE 300
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-654-4221
-----------------------------------------------------
Fax | 720-596-5254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4466 DUSTY PINE TRL
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-7717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-654-4221
-----------------------------------------------------
Fax | 720-596-5254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JILLIAN JUST
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 720-654-4221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------