Provider Demographics
NPI:1699095273
Name:AGAPE SPECIALTY CARE CENTER INC.
Entity type:Organization
Organization Name:AGAPE SPECIALTY CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MTONGA
Authorized Official - Last Name:CHIMWALA
Authorized Official - Suffix:
Authorized Official - Credentials:R/N
Authorized Official - Phone:912-220-0958
Mailing Address - Street 1:7370 HODGSON MEMORIAL DR
Mailing Address - Street 2:SUITE E 11
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2536
Mailing Address - Country:US
Mailing Address - Phone:912-220-0958
Mailing Address - Fax:
Practice Address - Street 1:7370 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE E 11
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2536
Practice Address - Country:US
Practice Address - Phone:912-220-0958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025R0633251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health