Provider Demographics
NPI:1073360533
Name:AGAPE ADOPTION AGENCY OF ARIZONA, INC.
Entity type:Organization
Organization Name:AGAPE ADOPTION AGENCY OF ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REPROGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:602-659-7201
Mailing Address - Street 1:PO BOX 50246
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0246
Mailing Address - Country:US
Mailing Address - Phone:480-272-7994
Mailing Address - Fax:480-323-2064
Practice Address - Street 1:4302 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8808
Practice Address - Country:US
Practice Address - Phone:480-272-7994
Practice Address - Fax:480-323-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health