Provider Demographics
NPI:1598912537
Name:AGAPE HEALTH AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:AGAPE HEALTH AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY (J.R.)
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:2020 NORTHPARK
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3127
Mailing Address - Country:US
Mailing Address - Phone:423-975-5455
Mailing Address - Fax:423-975-5405
Practice Address - Street 1:2020 NORTHPARK
Practice Address - Street 2:SUITE 2F
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3127
Practice Address - Country:US
Practice Address - Phone:423-975-5455
Practice Address - Fax:423-975-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility