Provider Demographics
NPI:1194072652
Name:AGAPE COMMUNITY INTEGRATED HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:AGAPE COMMUNITY INTEGRATED HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-564-6486
Mailing Address - Street 1:5536 OLD NATIONAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5181
Mailing Address - Country:US
Mailing Address - Phone:404-564-4796
Mailing Address - Fax:404-564-6487
Practice Address - Street 1:5536 OLD NATIONAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5181
Practice Address - Country:US
Practice Address - Phone:404-564-4796
Practice Address - Fax:404-564-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103TB0200X, 103TP2701X, 1041C0700X
GA261QC1500X, 261QM0801X, 261QM0850X, 320800000X
GA060-435-D261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness