Provider Demographics
NPI:1922425685
Name:AGAPE MIDWIFERY SERVICES INC
Entity Type:Organization
Organization Name:AGAPE MIDWIFERY SERVICES INC
Other - Org Name:AGAPE BIRTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MIDWIFE
Authorized Official - Phone:386-258-5400
Mailing Address - Street 1:1346 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5508
Mailing Address - Country:US
Mailing Address - Phone:386-258-5400
Mailing Address - Fax:386-258-5005
Practice Address - Street 1:1346 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5508
Practice Address - Country:US
Practice Address - Phone:386-258-5400
Practice Address - Fax:386-258-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340123500Medicaid