MEDICARE: AGAPE CHILDREN'S SERVICES 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	100508249	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699820779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE CHILDREN'S SERVICES INC

Provider Business Mailing Address
First Line	:	5431 LINDERO PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2714
Country	:	US
Telephone Number	:	702-739-7716
Fax Number	:	702-597-2242

Provider Business Practice Location Address
First Line	:	5431 LINDERO PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2714
Country	:	US
Telephone Number	:	702-739-7716
Fax Number	:	702-597-2242

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRYAN F LINK
Credential	:	MSW LSW
Telephone Number	:	702-739-7716

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	06/24/2008

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