Provider Demographics
NPI:1699328245
Name:ST. AGNES HEALTHCARE, INC.
Entity type:Organization
Organization Name:ST. AGNES HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-368-3130
Mailing Address - Street 1:3585 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1676
Mailing Address - Country:US
Mailing Address - Phone:667-234-2149
Mailing Address - Fax:667-234-8644
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:667-234-2800
Practice Address - Fax:667-234-3532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. AGNES HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty