Provider Demographics
NPI:1568645588
Name:THE AGAPE HEALTH GROUP, INC
Entity Type:Organization
Organization Name:THE AGAPE HEALTH GROUP, INC
Other - Org Name:AGAPE HEALTH AND LIFE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-203-4304
Mailing Address - Street 1:7312 RIVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1031
Mailing Address - Country:US
Mailing Address - Phone:301-203-4304
Mailing Address - Fax:
Practice Address - Street 1:7312 RIVERHILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-203-4304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2511251J00000X, 253Z00000X
MD1307002251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3954021-00Medicaid
MD1839021-00Medicaid