Provider Demographics
NPI:1346604410
Name:FRIENDS OF AGAPE INC.
Entity Type:Organization
Organization Name:FRIENDS OF AGAPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MIM
Authorized Official - Phone:314-568-8787
Mailing Address - Street 1:10990 NEW HALLS FERRY RD
Mailing Address - Street 2:J118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4497
Mailing Address - Country:US
Mailing Address - Phone:314-568-8787
Mailing Address - Fax:314-431-3005
Practice Address - Street 1:8403 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2815
Practice Address - Country:US
Practice Address - Phone:314-568-8787
Practice Address - Fax:314-431-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1299261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care