Provider Demographics
NPI:1699820779
Name:AGAPE CHILDREN'S SERVICES INC
Entity Type:Organization
Organization Name:AGAPE CHILDREN'S SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LSW
Authorized Official - Phone:702-739-7716
Mailing Address - Street 1:5431 LINDERO PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2714
Mailing Address - Country:US
Mailing Address - Phone:702-739-7716
Mailing Address - Fax:702-597-2242
Practice Address - Street 1:5431 LINDERO PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2714
Practice Address - Country:US
Practice Address - Phone:702-739-7716
Practice Address - Fax:702-597-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV100508249322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511852Medicaid
NV100511853Medicaid
NV100511851Medicaid
NV100508249Medicaid