| Agape Community Health Center, Inc. - South Jax | |
|
3900 University Blvd S Ste 2 Jacksonville FL 32216-4331 | |
| (904) 760-4940 | |
| (904) 647-2481 |
| Full Name | Agape Community Health Center, Inc. - South Jax |
|---|---|
| Speciality | Clinic/Center |
| Location | 3900 University Blvd S Ste 2, Jacksonville, Florida |
| Authorized Official Name and Position | Mia L Jones (CEO) |
| Authorized Official Contact | 9047604904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agape Community Health Center, Inc. - South Jax 120 King Street Jacksonville FL 32204-4393 Ph: (904) 760-4940 | Agape Community Health Center, Inc. - South Jax 3900 University Blvd S Ste 2 Jacksonville FL 32216-4331 Ph: (904) 760-4940 |
| NPI Number | 1245695774 |
|---|---|
| Provider Enumeration Date | 12/29/2015 |
| Last Update Date | 09/09/2020 |
| Medicare PECOS PAC ID | 3476500695 |
|---|---|
| Medicare Enrollment ID | O20170131000761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245695774 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | N04000004094 (Florida) | Primary |
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