Provider Demographics
NPI:1104672666
Name:AGNESCARE SERVICE SOLUTIONS, INC
Entity type:Organization
Organization Name:AGNESCARE SERVICE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STECY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:708-497-0734
Mailing Address - Street 1:2728 JOHN MILLS RD
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21710-8930
Mailing Address - Country:US
Mailing Address - Phone:708-497-0734
Mailing Address - Fax:
Practice Address - Street 1:7777 LEESBURG PIKE # 304
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2411
Practice Address - Country:US
Practice Address - Phone:708-497-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)