Healthcare Provider Details

I. General information

NPI: 1609317122
Provider Name (Legal Business Name): AMERICAN GROUP FITNESS, AGX-LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MAYFLOWER CT BUSH STREET
PIKESVILLE MD
21208-6043
US

IV. Provider business mailing address

4 MAYFLOWER COURT
PIKESVILLE MD
21208
US

V. Phone/Fax

Practice location:
  • Phone: 443-839-6240
  • Fax:
Mailing address:
  • Phone: 443-839-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DEANDRE WELLS
Title or Position: FOUNDER/CEO
Credential: GROUP EXCER TRAIN
Phone: 443-839-6240