AGAPE RECOVERY HOUSE LLC NPI 1053982827

NPI Information

NPI: 1053982827
Provider Name: AGAPE RECOVERY HOUSE LLC
Classification: Clinic/Center - 261QR0405X
Specialization: Rehabilitation, Substance Use Disorder
Entity Type: Organization
Doing Business As: INNER VOYAGE RECOVERY CENTER
CLIA Number: 11D1079877
Address: 2230 TOWNE LAKE PKWY STE 200
WOODSTOCK, GA
ZIP 30189
Phone: (404) 713-4280

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NPI Details

AGAPE RECOVERY HOUSE LLC is a rehabilitation and substance use disorder clinic center in Woodstock, GA. AGAPE RECOVERY HOUSE LLC NPI is 1053982827. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Inner Voyage Recovery Center.

The provider's business location address is:

2230 TOWNE LAKE PKWY STE 200
WOODSTOCK, GA
ZIP 30189-540
Phone: (404) 713-4280

The provider's authorized official is Jeff Bennett Baucom .
The authorized official title is Owner/operator and has the following contact phone number (404) 713-4280.

The CLIA number assigned to this NPI record is 11D1079877 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2021 and was last updated on 8/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
2	261QH0100X	Clinic/Center	Health Service	No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	Yes
4	324500000X	Substance Abuse Rehabilitation Facility		No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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