Organization
AGAPE LIFE PREVENTION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIARA BRACEY (PREVENTION SPECIALIST)
(678) 437-7350
Entity
Organization
Contact information
Practice address
6071 HIGHWAY 85 APT 31A, RIVERDALE, GA 30274-1531
(678) 437-7350
Mailing address
6691 CHURCH ST # 960843, RIVERDALE, GA 30274-2213
(678) 437-7350
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
GA
Enumeration date
06/30/2022
Last updated
06/30/2022
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