MEDICARE: AGAPE COMMUNITY HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	N04000004094	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578928826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	5460 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1957
Country	:	US
Telephone Number	:	904-760-4904
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1957
Country	:	US
Telephone Number	:	904-760-4904
Fax Number	:	904-779-5263

Authorized Official
Title or Position	:	CEO
Name	:	MS. MIA L JONES
Credential	:
Telephone Number	:	904-760-4904

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/22/2022

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