{
"Npi": {
"NPI": "1982347472",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AGAPE BEHAVIORAL CENTER LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1164 E OAKLAND PARK BLVD",
"SecondLineMailingAddress": "STE 101",
"MailingAddressCityName": "OAKLAND PARK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33334-2709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "754-200-4373",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5081 NW DUNN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT PIERCE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34981-4942",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-362-5651",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/14/2022",
"LastUpdateDate": "04/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAVROOKAS",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "JONATHAN",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "754-200-4373",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "323P00000X",
"TaxonomyName": "Psychiatric Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}