| Organization Name: | AGM IOP/PHP, LLC |
| NPI Number: | 1346630803 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANCO SICURO (OWNER) |
| Mailing Address: | 10199 Woodfield Ln Olivette |
| State: | MO US |
| Postal Code: | 631322922 |
| Phone Number: | 3142822517 |
| Fax Number: | 3148452798 |
| NPI Enumeration Date: | 02/04/2015 |
| NPI Last Update Date: | 02/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | LC001426559 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |