Provider Demographics
NPI:1447623566
Name:AGAPE HEALTH CENTER
Entity type:Organization
Organization Name:AGAPE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-239-1400
Mailing Address - Street 1:1732 OLD GALLATIN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-8900
Mailing Address - Country:US
Mailing Address - Phone:270-239-1400
Mailing Address - Fax:270-239-1402
Practice Address - Street 1:1732 OLD GALLATIN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-8900
Practice Address - Country:US
Practice Address - Phone:270-239-1400
Practice Address - Fax:270-239-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006385261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center