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General NPI Number Information
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NPI Number | 1013609429
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Entity Type | Organization
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Legal Business Name | AGAPE REHABILITATION AND REINTEGRATION SERVICES LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 8925 N 43RD AVE STE 5
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City | PHOENIX
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State | AZ
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Zip | 85051-3616
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Country | US
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Telephone | 480-430-3992
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 W PEORIA AVE APT 5054
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City | GLENDALE
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State | AZ
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Zip | 85302-1204
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Country | US
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Telephone | 480-430-3992
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KAMAU JOHN
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Credential |
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Telephone | 480-430-3992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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