Organization
AGAPE COMMUNITY HEALTH MOBILE UNIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLIAN SCHELLHAMMER (CREDENTIALING SPECIALIST)
(904) 800-6347
Entity
Organization
Contact information
Practice address
1880 EDGEWOOD AVE S, JACKSONVILLE, FL 32205-9118
(904) 760-4904
Mailing address
120 KING ST, JACKSONVILLE, FL 32204-2410
(904) 800-6347
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017234418
—
FL
Enumeration date
08/11/2021
Last updated
08/11/2021
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