Healthcare Provider Details

I. General information

NPI: 1982201133
Provider Name (Legal Business Name): AGAPE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17801 NW 2ND AVE STE 212
MIAMI GARDENS FL
33169-5029
US

IV. Provider business mailing address

22790 SW 112TH AVE
MIAMI FL
33170-7602
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-2616
  • Fax: 305-235-6178
Mailing address:
  • Phone: 305-235-2616
  • Fax: 305-235-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIA GABRIELA VARGAS
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 305-235-2616