Provider Demographics
NPI:1851732705
Name:AGAPE PCS, LLC
Entity Type:Organization
Organization Name:AGAPE PCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JACOB-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DEGREED
Authorized Official - Phone:225-751-2409
Mailing Address - Street 1:5917 JONES CREEK RD
Mailing Address - Street 2:STE 200A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3000
Mailing Address - Country:US
Mailing Address - Phone:225-751-2409
Mailing Address - Fax:225-751-2466
Practice Address - Street 1:5917 JONES CREEK RD
Practice Address - Street 2:STE 200A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3000
Practice Address - Country:US
Practice Address - Phone:225-751-2409
Practice Address - Fax:225-751-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15083253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15083Medicaid