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)

General Provider Information

NPI Number	:	1912838806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	120 KING ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-2410
Country	:	US
Telephone Number	:	904-760-5904
Fax Number	:	904-930-4607

Provider Business Practice Location Address
First Line	:	1700 OLD MIDDLEBURG RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1232
Country	:	US
Telephone Number	:	904-760-5904
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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