Healthcare Provider Details

I. General information

NPI: 1740908243
Provider Name (Legal Business Name): AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MARYLAND AVENUE SUITE 1A
BALTIMORE MD
21218
US

IV. Provider business mailing address

2323 MARYLAND AVENUE SUITE 1A
BALTIMORE MD
21218-5029
US

V. Phone/Fax

Practice location:
  • Phone: 443-934-0084
  • Fax:
Mailing address:
  • Phone: 240-515-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMOH ADEPOJU ADEBAYO
Title or Position: CEO
Credential:
Phone: 240-515-4868