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General NPI Number Information
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NPI Number | 1326411455
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Entity Type | Organization
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Legal Business Name | AGAPE BHH ADDICTION TREATMENT CENTER
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 928 S BROADWAY ST STE M-9
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City | WICHITA
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State | KS
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Zip | 67211-2229
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Country | US
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Telephone | 316-390-0840
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3998
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City | WICHITA
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State | KS
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Zip | 67201-3998
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Country | US
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Telephone | 316-390-0840
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MS. ROSEMARY NJOROGE
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Credential |
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Telephone | 316-390-0840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001S002X
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License Number State | KS
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