Provider Demographics
NPI:1083191514
Name:AGAPE CARE
Entity Type:Organization
Organization Name:AGAPE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JADA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-501-2123
Mailing Address - Street 1:4836 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7013
Mailing Address - Country:US
Mailing Address - Phone:772-577-6783
Mailing Address - Fax:772-252-4082
Practice Address - Street 1:4836 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7013
Practice Address - Country:US
Practice Address - Phone:772-577-6783
Practice Address - Fax:772-252-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022884900Medicaid
FL003014400Medicaid