Provider Demographics
NPI:1205511334
Name:THE AGAPE CLINIC
Entity type:Organization
Organization Name:THE AGAPE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-707-7782
Mailing Address - Street 1:4104 JUNIUS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1427
Mailing Address - Country:US
Mailing Address - Phone:972-707-7776
Mailing Address - Fax:
Practice Address - Street 1:4104 JUNIUS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1427
Practice Address - Country:US
Practice Address - Phone:972-707-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty