Provider Demographics
NPI:1275913881
Name:AGAPE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:AGAPE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-362-1600
Mailing Address - Street 1:2300 GARRISON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2316
Mailing Address - Country:US
Mailing Address - Phone:410-362-1600
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2316
Practice Address - Country:US
Practice Address - Phone:410-362-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty