Organization
AGAPE NURSING & REHABILITATION CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M. CAWOOD-GRAY (RISK CONSULTANT)
(423) 773-4485
Entity
Organization
Contact information
Practice address
105 W MYRTLE AVE, JOHNSON CITY, TN 37604-5633
(423) 975-5455
(423) 975-5405
Mailing address
2020 NORTHPARK DR, SUITE 2D, JOHNSON CITY, TN 37604-3100
(423) 975-5455
(423) 975-5405
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
TN
314000000X
Skilled Nursing Facility
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445019
—
TN
05
—
7440618
—
TN
Enumeration date
06/26/2014
Last updated
01/28/2015
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