Basic Information
| Provider Information | |||||||||
| NPI: | 1558537381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGAPE THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1053 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291696749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034540365 | ||||||||
| FaxNumber: | 8034046001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2705 LEAPHART RD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039265119 | ||||||||
| FaxNumber: | 8039263035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | VERTES | ||||||||
| AuthorizedOfficialFirstName: | ALISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8034540365 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.