Organization
AGAPE PSYCHIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNINAH OBWAYA (CEO/NURSE PRACTITIONER)
(610) 202-6770
Entity
Organization
Contact information
Practice address
10913 131ST AVE N, CHAMPLIN, MN 55316-1143
(610) 202-6770
Mailing address
10913 131ST AVE N, CHAMPLIN, MN 55316-1143
(610) 202-6770
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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