Provider Demographics
NPI:1972314664
Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:AGATE INTEGRATED AND BEHAVIORAL HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIMOH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-515-4868
Mailing Address - Street 1:3216 GREENMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3438
Mailing Address - Country:US
Mailing Address - Phone:443-934-0084
Mailing Address - Fax:443-885-9840
Practice Address - Street 1:3216 GREENMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3438
Practice Address - Country:US
Practice Address - Phone:443-934-0084
Practice Address - Fax:443-885-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness