Organization
AGAPE RECOVERY HOUSE LLC
Active
Other names
Inner Voyage Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF BENNETT BAUCOM CACI (OWNER/OPERATOR)
(404) 713-4280
Entity
Organization
Contact information
Practice address
2230 TOWNE LAKE PKWY STE 200, WOODSTOCK, GA 30189-5540
(404) 713-4280
Mailing address
2230 TOWNE LAKE PKWY, BLDG 900 STE 200, WOODSTOCK, GA 30189-5546
(404) 713-4280
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/02/2021
Last updated
08/26/2024
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