Provider Demographics
NPI:1689615064
Name:AGAPE NURSING & REHABILITATION, INC.
Entity Type:Organization
Organization Name:AGAPE NURSING & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-454-0365
Mailing Address - Street 1:300 AGAPE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3307
Mailing Address - Country:US
Mailing Address - Phone:803-739-5282
Mailing Address - Fax:803-936-8970
Practice Address - Street 1:300 AGAPE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3307
Practice Address - Country:US
Practice Address - Phone:803-739-5282
Practice Address - Fax:803-936-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF837314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0837NFMedicaid
425379Medicare ID - Type Unspecified