MEDICARE: AGAVE HEALTH 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	103TC1900X	Counseling Psychologist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639038839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAVE HEALTH INC

Provider Business Mailing Address
First Line	:	359 5TH ST UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2329
Country	:	US
Telephone Number	:	551-302-1794
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 5TH ST UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2329
Country	:	US
Telephone Number	:	551-302-1794
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ORI FRUHAUF
Credential	:
Telephone Number	:	551-302-1794

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “AGAVE HEALTH INC ” Practice Location

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