Provider Demographics
NPI:1215148010
Name:AGAPE' COMPREHENSIVE HEALTH SERVICE
Entity type:Organization
Organization Name:AGAPE' COMPREHENSIVE HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROOMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MS
Authorized Official - Phone:580-351-2273
Mailing Address - Street 1:207 SW C AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4648
Mailing Address - Country:US
Mailing Address - Phone:580-351-2273
Mailing Address - Fax:580-351-1475
Practice Address - Street 1:207 SW C AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4648
Practice Address - Country:US
Practice Address - Phone:580-351-2273
Practice Address - Fax:580-351-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7296251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377522Medicare ID - Type UnspecifiedHHA