Provider Demographics
NPI:1891027751
Name:AGAPE COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:AGAPE COMMUNITY SERVICES INC.
Other - Org Name:AGAPE HOMECARE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-623-2422
Mailing Address - Street 1:3802 SUGAR PALM DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1312
Mailing Address - Country:US
Mailing Address - Phone:813-623-2422
Mailing Address - Fax:813-623-2419
Practice Address - Street 1:3802 SUGAR PALM DR
Practice Address - Street 2:SUITE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1312
Practice Address - Country:US
Practice Address - Phone:813-623-2422
Practice Address - Fax:813-623-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692104396251C00000X
FL692104300251E00000X
FL69214300253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692104396Medicaid
FL692104300Medicaid
FL230209OtherAHCA