Healthcare Provider Details

I. General information

NPI: 1518573096
Provider Name (Legal Business Name): AGILE TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 09/19/2020
Certification Date: 09/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E MONROE ST STE 3800
CHICAGO IL
60603-6030
US

IV. Provider business mailing address

55 E MONROE ST STE 3800
CHICAGO IL
60603-6030
US

V. Phone/Fax

Practice location:
  • Phone: 312-388-3513
  • Fax:
Mailing address:
  • Phone: 877-424-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RODERICK MARTIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 877-424-4534