Provider Demographics
NPI:1871245811
Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:
Authorized Official - Phone:240-515-4868
Mailing Address - Street 1:2323 MARYLAND AVENUE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:443-934-0084
Mailing Address - Fax:
Practice Address - Street 1:2323 MARYLAND AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
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:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1629653894Medicaid
MD1609470327Medicaid