Provider Demographics
NPI:1598987455
Name:AGAPE HOSPICE CARE OF RUSTON, LLC
Entity Type:Organization
Organization Name:AGAPE HOSPICE CARE OF RUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-798-2648
Mailing Address - Street 1:1503 GOODWIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2948
Mailing Address - Country:US
Mailing Address - Phone:318-513-1112
Mailing Address - Fax:
Practice Address - Street 1:1503 GOODWIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2948
Practice Address - Country:US
Practice Address - Phone:318-513-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191652Medicare Oscar/Certification