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General NPI Number Information
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NPI Number | 1699820779
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Entity Type | Organization
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Legal Business Name | AGAPE CHILDREN'S SERVICES INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 5431 LINDERO PL
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City | LAS VEGAS
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State | NV
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Zip | 89119-2714
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Country | US
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Telephone | 702-739-7716
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Fax | 702-597-2242
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Provider Business Mailing Address
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Address Line | 5431 LINDERO PL
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City | LAS VEGAS
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State | NV
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Zip | 89119-2714
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Country | US
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Telephone | 702-739-7716
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Fax | 702-597-2242
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRYAN F LINK
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Credential | MSW LSW
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Telephone | 702-739-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 100508249
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License Number State | NV
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