MEDICARE: AGAPE HEALTHCARE SERVICES 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	251E00000X	Home Health Agency	381466	MN

General Provider Information

NPI Number	:	1790296168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	6040 EARLE BROWN DR STE 270
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-4527
Country	:	US
Telephone Number	:	763-703-5986
Fax Number	:	763-600-6102

Provider Business Practice Location Address
First Line	:	6040 EARLE BROWN DR STE 270
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-4527
Country	:	US
Telephone Number	:	763-703-5986
Fax Number	:	763-600-6102

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ALFRED ZACCHEUS PAYNE SR.
Credential	:
Telephone Number	:	763-234-6433

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	11/09/2017

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Directions to “AGAPE HEALTHCARE SERVICES INC ” Practice Location

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