Organization
AGAPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRELL G PROVINSE (PRESIDENT/EXECUTIVE DIRECTOR)
(314) 994-9344
Entity
Organization
Contact information
Practice address
9378 OLIVE BLVD, SUITE 317, OLIVETTE, MO 63132-3215
(314) 994-9344
Mailing address
9378 OLIVE BLVD, SUITE 317, OLIVETTE, MO 63132-3215
(314) 994-9344
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
180-001482
IL
251S00000X
Community/Behavioral Health Agency
Primary
2003031617
MO
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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