Provider Demographics
NPI:1609470327
Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES INC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMOH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:240-515-4868
Mailing Address - Street 1:2323 MARYLAND AVE. SUITE 1A
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5029
Mailing Address - Country:US
Mailing Address - Phone:443-934-0084
Mailing Address - Fax:
Practice Address - Street 1:2323 MARYLAND AVE. SUITE 1A
Practice Address - Street 2:SUITE 1A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5029
Practice Address - Country:US
Practice Address - Phone:443-934-0084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)