Organization
AGAPELIFE HEALTH GROUP, LLC
Active
Other names
BrightStar Care of the Beaches & Ponte Vedra
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA I HART MPH (OWNER, AGENCY DIRECTOR)
(904) 807-9955
Entity
Organization
Contact information
Practice address
12187 BEACH BLVD, SUITE 7, JACKSONVILLE, FL 32246-0676
(904) 807-9955
(904) 807-9954
Mailing address
3545 SAINT JOHNS BLUFF RD S, 1-214, JACKSONVILLE, FL 32224-2682
(904) 807-9955
(904) 807-9954
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
1514
FL
251E00000X
Home Health Agency
Primary
299994085
FL
253Z00000X
In Home Supportive Care Agency
299994085
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2043310
CLIA WAIVER
FL
01
—
1514
HEALTH CARE SERVICES POOL
FL
01
—
232597
ACHA HOMEMAKER COMPANION LICENSE
FL
01
—
299994085
ACHA HOME HEALTH AGENCY LICENSE
FL
Enumeration date
06/04/2012
Last updated
03/12/2013
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