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General NPI Number Information
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NPI Number | 1275073488
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Entity Type | Organization
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Legal Business Name | AGAPE ADVANCED INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1601 NE 26TH ST
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City | WILTON MANORS
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State | FL
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Zip | 33305-1410
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Country | US
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Telephone | 888-981-9107
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 E OAKLAND PARK BLVD STE 101
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City | OAKLAND PARK
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State | FL
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Zip | 33334-2709
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Country | US
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Telephone | 754-200-4373
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE J MAVROOKAS
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Credential |
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Telephone | 754-200-4373
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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 | 0618128360001
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0601
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License Number State | FL
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