Provider Demographics
NPI:1659919728
Name:ST. AGNES HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ST. AGNES HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:667-234-3130
Mailing Address - Street 1:900 S. CATON AVENUE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229
Mailing Address - Country:US
Mailing Address - Phone:667-234-2550
Mailing Address - Fax:667-234-7917
Practice Address - Street 1:900 S. CATON AVENUE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:667-234-2550
Practice Address - Fax:667-234-7917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. AGNES HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy