Provider Demographics
NPI:1992318802
Name:AGAPE FAMILY FIRST HEALTH AND WELLNESS CLINIC, LLC
Entity type:Organization
Organization Name:AGAPE FAMILY FIRST HEALTH AND WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:210-904-1166
Mailing Address - Street 1:645 WOODLAND OAKS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2888
Mailing Address - Country:US
Mailing Address - Phone:210-904-1166
Mailing Address - Fax:210-362-1143
Practice Address - Street 1:645 WOODLAND OAKS DR STE 300
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2888
Practice Address - Country:US
Practice Address - Phone:210-904-1166
Practice Address - Fax:210-362-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1983488-01Medicaid