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General NPI Number Information
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NPI Number | 1164783494
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Entity Type | Organization
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Legal Business Name | AGAPELIFE HEALTH GROUP, LLC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 12187 BEACH BLVD SUITE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32246-0676
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Country | US
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Telephone | 904-807-9955
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Fax | 904-807-9954
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Provider Business Mailing Address
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Address Line | 3545 SAINT JOHNS BLUFF RD S 1-214
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2682
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Country | US
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Telephone | 904-807-9955
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Fax | 904-807-9954
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Authorized Official
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Title or Position | OWNER, AGENCY DIRECTOR
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Name | ANDREA I HART
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Credential | MPH
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Telephone | 904-807-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1514
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 299994085
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299994085
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License Number State | FL
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