Healthcare Provider Details

I. General information

NPI: 1699820779
Provider Name (Legal Business Name): AGAPE CHILDREN'S SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 LINDERO PL
LAS VEGAS NV
89119-2714
US

IV. Provider business mailing address

5431 LINDERO PL
LAS VEGAS NV
89119-2714
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-7716
  • Fax: 702-597-2242
Mailing address:
  • Phone: 702-739-7716
  • Fax: 702-597-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number100508249
License Number StateNV

VIII. Authorized Official

Name: BRYAN F LINK
Title or Position: DIRECTOR
Credential: MSW LSW
Phone: 702-739-7716