MEDICARE: AGAPE BEHAVIORAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1225452493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE BEHAVIORAL CENTER

Provider Business Mailing Address
First Line	:	9025 W DESERT INN RD APT 154
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9025 W DESERT INN RD APT 154
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6306
Country	:	US
Telephone Number	:	702-505-5385
Fax Number	:

Authorized Official
Title or Position	:	BST
Name	:	JASMINE HOUSTON
Credential	:
Telephone Number	:	702-505-5385

Provider Enumeration Date	:	02/09/2014
Last Update Date	:	02/09/2014

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