Provider Demographics
NPI:1609023647
Name:AGAPE HOSPICE OF NORTHEAST GEORGIA, INC.
Entity Type:Organization
Organization Name:AGAPE HOSPICE OF NORTHEAST GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-454-0365
Mailing Address - Street 1:137 N BROAD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2152
Mailing Address - Country:US
Mailing Address - Phone:770-586-5103
Mailing Address - Fax:770-586-5108
Practice Address - Street 1:137 N BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2152
Practice Address - Country:US
Practice Address - Phone:770-586-5103
Practice Address - Fax:770-586-5108
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 Licenses
StateLicense IDTaxonomies
GA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based