| Agape | |
|
9378 Olive Blvd Suite 317 Olivette MO 63132-3215 | |
| (314) 994-9344 | |
| Not Available |
| Full Name | Agape |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9378 Olive Blvd, Olivette, Missouri |
| Authorized Official Name and Position | Darrell G Provinse (PRESIDENT/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3149949344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Agape 9378 Olive Blvd Suite 317 Olivette MO 63132-3215 Ph: (314) 994-9344 | Agape 9378 Olive Blvd Suite 317 Olivette MO 63132-3215 Ph: (314) 994-9344 |
| NPI Number | 1235522673 |
|---|---|
| Provider Enumeration Date | 03/10/2015 |
| Last Update Date | 03/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235522673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180-001482 (Illinois) | Secondary |
| 251S00000X | Community/behavioral Health | 2003031617 (Missouri) | Primary |
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