Provider Demographics
NPI:1164699534
Name:TEAM AGAPE INCORPORATED
Entity Type:Organization
Organization Name:TEAM AGAPE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:304-341-0400
Mailing Address - Street 1:885 WESTMINISTER WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2015
Mailing Address - Country:US
Mailing Address - Phone:304-341-0400
Mailing Address - Fax:304-341-0401
Practice Address - Street 1:885 WESTMINISTER WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2015
Practice Address - Country:US
Practice Address - Phone:304-345-7700
Practice Address - Fax:304-345-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Yes251S00000XAgenciesCommunity/Behavioral Health