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General NPI Number Information
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NPI Number | 1265842215
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Entity Type | Organization
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Legal Business Name | AGAPE CONSULTANT SERVICES LLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 284 MCNEIL MILL RD
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-3504
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Country | US
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Telephone | 540-819-8346
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Fax | 188-844-8974
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Provider Business Mailing Address
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Address Line | PO BOX 2146
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-8446
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Country | US
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Telephone | 540-420-4299
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Fax | 188-844-8974
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Authorized Official
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Title or Position | OWNER-SOLE PROPRIETOR
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Name | CATHY N MATTOX
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Credential | RN,MSN,MBA
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Telephone | 540-420-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0001170205
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License Number State | VA
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