MEDICARE: AGAPE COMMUNITY INTEGRATED HEALTH SYSTEMS, INC

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QC1500X	Community Health Clinic/Center
4	101Y00000X	Counselor
5	103TB0200X	Cognitive & Behavioral Psychologist
6	103TP2701X	Group Psychotherapy Psychologist
7	1041C0700X	Clinical Social Worker
8	261QM0850X	Adult Mental Health Clinic/Center
9	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	060-435-D	GA
10	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1578090601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COMMUNITY INTEGRATED HEALTH SYSTEMS, INC

Provider Business Mailing Address
First Line	:	P.O. BOX 10938
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310
Country	:	US
Telephone Number	:	404-564-6486
Fax Number	:	404-564-6487

Provider Business Practice Location Address
First Line	:	5536 OLD NATIONAL HWY
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30349
Country	:	US
Telephone Number	:	404-564-4796
Fax Number	:	404-564-6487

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MS. AISHA D. FRAZIER
Credential	:
Telephone Number	:	404-564-6486

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	05/08/2024

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