Healthcare Provider Details

I. General information

NPI: 1639038839
Provider Name (Legal Business Name): AGAVE HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 5TH ST UNIT 3
JERSEY CITY NJ
07302-2329
US

IV. Provider business mailing address

359 5TH ST UNIT 3
JERSEY CITY NJ
07302-2329
US

V. Phone/Fax

Practice location:
  • Phone: 551-302-1794
  • Fax:
Mailing address:
  • Phone: 551-302-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ORI FRUHAUF
Title or Position: CEO
Credential:
Phone: 551-302-1794