Provider Demographics
NPI:1265842215
Name:AGAPE CONSULTANT SERVICES LLC
Entity Type:Organization
Organization Name:AGAPE CONSULTANT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,MBA
Authorized Official - Phone:540-420-4299
Mailing Address - Street 1:PO BOX 2146
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-8446
Mailing Address - Country:US
Mailing Address - Phone:540-420-4299
Mailing Address - Fax:188-844-8974
Practice Address - Street 1:284 MCNEIL MILL RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-3504
Practice Address - Country:US
Practice Address - Phone:540-819-8346
Practice Address - Fax:188-844-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001170205253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518226653OtherINDIVIDUAL NPI-CATHY MATTOX