NPIMap

Organization Active NPI

Agape Life Prevention Center

  • Community/Behavioral Health Agency
  • Riverdale, GA
National Provider Identifier
1780316489
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
AGAPE LIFE PREVENTION CENTER
Practice address
6071 Highway 85 Apt 31a
Riverdale, GA 30274-1531
Phone
(678) 437-7350
NPI assigned
Jun 30, 2022
Last updated
Jun 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tiara BraceyNPI 1619609310
Title
Prevention Specialist
Phone
(678) 437-7350

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Public Health or Welfare Agency 251K00000X
Meals Provider 174200000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

6071 Highway 85 Apt 31a
Riverdale, GA 30274-1531

Mailing address

6691 Church St # 960843
Riverdale, GA 30274-2213
Phone (678) 437-7350

Other identifiers 1

IdentifierTypeStateIssuer
000000MedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1780316489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6691 CHURCH ST # 960843",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742213",
            "telephone_number": "678-437-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6071 HIGHWAY 85 APT 31A",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302741531",
            "telephone_number": "678-437-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE LIFE PREVENTION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "BRACEY",
        "authorized_official_first_name": "TIARA",
        "authorized_official_title_or_position": "PREVENTION SPECIALIST",
        "authorized_official_telephone_number": "678-437-7350"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.