Provider Demographics
NPI:1609317122
Name:AMERICAN GROUP FITNESS, AGX-LLC
Entity Type:Organization
Organization Name:AMERICAN GROUP FITNESS, AGX-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:GROUP EXCER TRAIN
Authorized Official - Phone:443-839-6240
Mailing Address - Street 1:4 MAYFLOWER COURT
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:443-839-6240
Mailing Address - Fax:
Practice Address - Street 1:4 MAYFLOWER CT
Practice Address - Street 2:BUSH STREET
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6043
Practice Address - Country:US
Practice Address - Phone:443-839-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No251E00000XAgenciesHome Health