Provider Demographics
NPI:1093453102
Name:AGAPE HEALTH CLINIC
Entity Type:Organization
Organization Name:AGAPE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, ND, LAC
Authorized Official - Phone:503-926-9529
Mailing Address - Street 1:505 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3578
Mailing Address - Country:US
Mailing Address - Phone:503-926-9529
Mailing Address - Fax:503-961-8698
Practice Address - Street 1:505 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3578
Practice Address - Country:US
Practice Address - Phone:503-926-9529
Practice Address - Fax:503-961-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center