Provider Demographics
NPI:1386811818
Name:AGAPE NURSING SERVICES, INC.
Entity type:Organization
Organization Name:AGAPE NURSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:252-830-9222
Mailing Address - Street 1:PO BOX 30321
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0321
Mailing Address - Country:US
Mailing Address - Phone:252-830-9222
Mailing Address - Fax:252-756-4220
Practice Address - Street 1:3195 E TENTH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4276
Practice Address - Country:US
Practice Address - Phone:252-830-9222
Practice Address - Fax:252-756-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1775251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100352Medicaid
NC0080KOtherBCBS
NC0070SOtherBCBS
NC6600741Medicaid
NC3409268Medicaid