Provider Demographics
NPI:1982201133
Name:AGAPE NETWORK, INC.
Entity Type:Organization
Organization Name:AGAPE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GABRIELA
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-235-2616
Mailing Address - Street 1:22790 SW 112TH AVE
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 1:17801 NW 2ND AVE STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5029
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:2020-10-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360010600Medicaid
FL000199000Medicaid
FL306725OtherWELLCARE