Basic Information
| Provider Information | |||||||||
| NPI: | 1134354301 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AGAPE CHILDREN'S SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 E TROPICANA AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027397716 | ||||||||
| FaxNumber: | 7025972242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 E TROPICANA AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027397716 | ||||||||
| FaxNumber: | 7025972242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 05/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | LINK | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7027397716 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, LSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1295974632 | 05 | NV | MEDICAID | 1669820779 | 05 | NV | MEDICAID | 9005048465 | 05 | NV | MEDICAID | 1821212051 | 05 | NV | MEDICAID | 9005048457 | 05 | NV | MEDICAID |