Provider Demographics
NPI:1154667947
Name:AGAPE COMMUNITY HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:AGAPE COMMUNITY HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELONI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:314-637-6000
Mailing Address - Street 1:3004 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1513
Mailing Address - Country:US
Mailing Address - Phone:314-775-8153
Mailing Address - Fax:314-473-5615
Practice Address - Street 1:3004 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1513
Practice Address - Country:US
Practice Address - Phone:314-775-8153
Practice Address - Fax:314-473-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-24
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO135103251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care