| Agile Healthcare Llc | |
|
116 W 21st St First Floor Baltimore MD 21218-5908 | |
| (443) 455-0074 | |
| Not Available |
| Full Name | Agile Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 116 W 21st St, Baltimore, Maryland |
| Authorized Official Name and Position | Olayinka F. Sarumi (CEO) |
| Authorized Official Contact | 4434550074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agile Healthcare Llc 1515 Fitzpatrick Dr Severn MD 21144-3142 Ph: (443) 455-0074 | Agile Healthcare Llc 116 W 21st St First Floor Baltimore MD 21218-5908 Ph: (443) 455-0074 |
| NPI Number | 1992488142 |
|---|---|
| Provider Enumeration Date | 08/14/2023 |
| Last Update Date | 10/06/2023 |
| Certification Date | 10/06/2023 |
| Medicare PECOS PAC ID | 0547608341 |
|---|---|
| Medicare Enrollment ID | O20240328003594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992488142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Aruna Ikharia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285368969 PECOS PAC ID: 8921471053 Enrollment ID: I20230315000019 |
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