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General NPI Number Information
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NPI Number | 1386326122
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Entity Type | Organization
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Legal Business Name | AGAPE COMMUNITY HEALTH CENTERS, INC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1680 DUNN AVE STE 38
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4744
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Country | US
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Telephone | 904-769-4904
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Fax |
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Provider Business Mailing Address
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Address Line | 120 KING ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING CONSULTANT
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Name | JAMES HAYDEN
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Credential |
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Telephone | 937-825-8631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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