Provider Demographics
NPI:1982368379
Name:AGAPE BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:AGAPE BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LLKEITH
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICDC
Authorized Official - Phone:419-297-0424
Mailing Address - Street 1:702 MCCLURG RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6400
Mailing Address - Country:US
Mailing Address - Phone:419-297-0424
Mailing Address - Fax:330-953-1818
Practice Address - Street 1:702 MCCLURG RD STE 2
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6400
Practice Address - Country:US
Practice Address - Phone:419-297-0424
Practice Address - Fax:330-953-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217988Medicaid