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General NPI Number Information
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NPI Number | 1982347472
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Entity Type | Organization
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Legal Business Name | AGAPE BEHAVIORAL CENTER LLC
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 5081 NW DUNN RD
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City | FORT PIERCE
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State | FL
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Zip | 34981-4942
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Country | US
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Telephone | 772-362-5651
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 E OAKLAND PARK BLVD STE 101
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City | OAKLAND PARK
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State | FL
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Zip | 33334-2709
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Country | US
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Telephone | 754-200-4373
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEORGE JONATHAN MAVROOKAS
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Credential |
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Telephone | 754-200-4373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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