Healthcare Provider Details

I. General information

NPI: 1871245811
Provider Name (Legal Business Name): AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 GREENMOUNT AVE
BALTIMORE MD
21218-3438
US

IV. Provider business mailing address

3218 GREENMOUNT AVENUE
BALTIMORE MD
21218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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