Provider Demographics
NPI:1538282272
Name:AGAPE UNLIMITED
Entity Type:Organization
Organization Name:AGAPE UNLIMITED
Other - Org Name:KOINONIA INN
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ONDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-373-1529
Mailing Address - Street 1:4841 AUTO CENTER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4388
Mailing Address - Country:US
Mailing Address - Phone:360-373-1529
Mailing Address - Fax:360-373-4051
Practice Address - Street 1:4841 AUTO CENTER WAY STE 101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4388
Practice Address - Country:US
Practice Address - Phone:360-373-1529
Practice Address - Fax:360-373-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18027300101YA0400X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1067521Medicaid
WA1990365Medicaid