Provider Demographics
NPI:1801658117
Name:AGAPE FAMILY WELLNESS
Entity type:Organization
Organization Name:AGAPE FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-770-8571
Mailing Address - Street 1:640 W MARYLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1398
Mailing Address - Country:US
Mailing Address - Phone:602-795-8122
Mailing Address - Fax:833-973-0963
Practice Address - Street 1:640 W MARYLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1398
Practice Address - Country:US
Practice Address - Phone:602-795-8122
Practice Address - Fax:833-973-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center