Provider Demographics
NPI:1407180680
Name:AGAPTIO RACOMA, MD, LLC
Entity Type:Organization
Organization Name:AGAPTIO RACOMA, MD, LLC
Other - Org Name:ASSOCIATED PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGAPITO
Authorized Official - Middle Name:
Authorized Official - Last Name:RACOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-751-0404
Mailing Address - Street 1:2620 ACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4737
Mailing Address - Country:US
Mailing Address - Phone:775-751-0404
Mailing Address - Fax:775-751-0405
Practice Address - Street 1:2620 ACOMA AVE
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4737
Practice Address - Country:US
Practice Address - Phone:775-751-0404
Practice Address - Fax:775-751-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5096C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty