Provider Demographics
NPI:1992488142
Name:AGILE HEALTHCARE LLC
Entity type:Organization
Organization Name:AGILE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SARUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-455-0074
Mailing Address - Street 1:1515 FITZPATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3142
Mailing Address - Country:US
Mailing Address - Phone:443-455-0074
Mailing Address - Fax:
Practice Address - Street 1:116 W 21ST ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5908
Practice Address - Country:US
Practice Address - Phone:443-455-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)