Provider Demographics
NPI:1013609429
Name:AGAPE REHABILITATION AND REINTEGRATION SERVICES LLC
Entity Type:Organization
Organization Name:AGAPE REHABILITATION AND REINTEGRATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMAU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-430-3992
Mailing Address - Street 1:5955 W PEORIA AVE APT 5054
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1204
Mailing Address - Country:US
Mailing Address - Phone:480-430-3992
Mailing Address - Fax:
Practice Address - Street 1:8925 N 43RD AVE STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3616
Practice Address - Country:US
Practice Address - Phone:480-430-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder