Provider Demographics
NPI:1154481356
Name:AGAPE HOMECARE PLUS INC.
Entity Type:Organization
Organization Name:AGAPE HOMECARE PLUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-502-2666
Mailing Address - Street 1:2142 FIGARO LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2142 FIGARO LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2926
Practice Address - Country:US
Practice Address - Phone:904-502-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688075496251E00000X
FL688075401251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688075401Medicaid
FL688075496Medicaid