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General NPI Number Information
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NPI Number | 1386223469
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Entity Type | Organization
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Legal Business Name | AGAPE HEALTH & WELLNESS CENTER INC.
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 6138 KENNERLY RD STE AND150
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4393
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Country | US
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Telephone | 386-283-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 11555 CENTRAL PKWY STE 601
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2698
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Country | US
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Telephone | 386-283-2010
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING/BILLING MANAGER
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Name | TIFFANY HART
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Credential |
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Telephone | 904-300-7494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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