Provider Demographics
NPI:1326191156
Name:AGAPE NETWORK, INC.
Entity Type:Organization
Organization Name:AGAPE NETWORK, INC.
Other - Org Name:SOUTH FLORIDA JAIL MINISTRIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LULL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:561-972-7771
Mailing Address - Street 1:22790 S.W. 112 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7602
Mailing Address - Country:US
Mailing Address - Phone:305-235-2616
Mailing Address - Fax:305-235-6178
Practice Address - Street 1:22790 S.W. 112 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7602
Practice Address - Country:US
Practice Address - Phone:305-235-2616
Practice Address - Fax:305-235-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD123002101Y00000X
FL1113AD123001324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360010600Medicaid
FL306725OtherWELLCARE
FL000199000Medicaid