Healthcare Provider Details

I. General information

NPI: 1336099613
Provider Name (Legal Business Name): AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 GREENMOUNT AVENUE
BALTIMORE MD
21218
US

IV. Provider business mailing address

3218 GREENMOUNT AVENUE
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 240-515-4868
  • Fax: 410-275-0466
Mailing address:
  • Phone: 240-515-4868
  • Fax: 410-275-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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