Provider Demographics
NPI:1275856387
Name:AGAPE THERAPY, LLC
Entity Type:Organization
Organization Name:AGAPE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-561-1300
Mailing Address - Street 1:6520 W HAPPY VALLEY RD
Mailing Address - Street 2:B-109
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2615
Mailing Address - Country:US
Mailing Address - Phone:623-561-1300
Mailing Address - Fax:623-561-0036
Practice Address - Street 1:6520 W HAPPY VALLEY RD
Practice Address - Street 2:B-109
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2615
Practice Address - Country:US
Practice Address - Phone:623-561-1300
Practice Address - Fax:623-561-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3353224Z00000X
AZ6233225100000X, 2251S0007X
225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty