Agapelife Health Group, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

299994085 Issued in FL

Legal business name

AGAPELIFE HEALTH GROUP, LLC

Doing business as

BrightStar Care of the Beaches & Ponte Vedra

Practice address

12187 Beach Blvd
Suite 7
Jacksonville, FL 32246-0676

Phone

(904) 807-9955

Fax

(904) 807-9954

NPI assigned

Jun 4, 2012

Last updated

Mar 12, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea I Hart, MPH

Title

Owner, Agency Director

Phone

(904) 807-9955

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• BrightStar Care of the Beaches & Ponte Vedra Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1164783494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 SAINT JOHNS BLUFF RD S",
            "address_2": "1-214",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242682",
            "telephone_number": "904-807-9955",
            "fax_number": "904-807-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12187 BEACH BLVD",
            "address_2": "SUITE 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322460676",
            "telephone_number": "904-807-9955",
            "fax_number": "904-807-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPELIFE HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER, AGENCY DIRECTOR",
        "authorized_official_telephone_number": "904-807-9955",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "1514",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299994085",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": "299994085",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACHA HOMEMAKER COMPANION LICENSE",
            "identifier": "232597",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACHA HOME HEALTH AGENCY LICENSE",
            "identifier": "299994085",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE SERVICES POOL",
            "identifier": "1514",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER",
            "identifier": "10D2043310",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BrightStar Care of the Beaches & Ponte Vedra",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Jacksonville, FL
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• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.