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General NPI Number Information
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NPI Number | 1508512237
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Entity Type | Organization
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Legal Business Name | AGAPE YOUTH HOMES LLC
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 3905 NW 89TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4476
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Country | US
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Telephone | 954-918-7948
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 NW 89TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4476
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Country | US
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Telephone | 954-918-7948
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. MARGARET MELANIE JORDAN
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Credential | MSTR HMN SVC COUNC
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Telephone | 964-918-7940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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