Provider Demographics
NPI:1356592752
Name:AGAPE TREATMENT SERVICES,LLC
Entity type:Organization
Organization Name:AGAPE TREATMENT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-242-1415
Mailing Address - Street 1:17 ACADEMY ST STE 1109
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2926
Mailing Address - Country:US
Mailing Address - Phone:973-242-1415
Mailing Address - Fax:
Practice Address - Street 1:17 ACADEMY ST STE 1109
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2926
Practice Address - Country:US
Practice Address - Phone:973-242-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ252Y00000X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management