Provider Demographics
NPI:1508512237
Name:AGAPE YOUTH HOMES LLC
Entity type:Organization
Organization Name:AGAPE YOUTH HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MELANIE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSTR HMN SVC COUNC
Authorized Official - Phone:964-918-7940
Mailing Address - Street 1:3905 NW 89TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4476
Mailing Address - Country:US
Mailing Address - Phone:954-918-7948
Mailing Address - Fax:
Practice Address - Street 1:3905 NW 89TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4476
Practice Address - Country:US
Practice Address - Phone:954-918-7948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDAN RIVER GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty