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General NPI Number Information
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NPI Number | 1922720333
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Entity Type | Organization
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Legal Business Name | AGAPE CLINIC INC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 2140 W 24TH ST STE B
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City | YUMA
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State | AZ
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Zip | 85364-8877
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Country | US
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Telephone | 928-459-3400
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Fax | 928-459-2077
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Provider Business Mailing Address
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Address Line | 2140 W 24TH ST STE B
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City | YUMA
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State | AZ
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Zip | 85364-8877
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Country | US
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Telephone | 928-503-4060
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Fax | 928-459-2077
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN ERNEST WILLIAMS
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Credential |
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Telephone | 928-459-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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