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Organization
AGILE PRIMARY CARE AND REHABILITATION SERVICES
Active
Organization
AGILE PRIMARY CARE AND REHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOSUNMOLA LAKE (MEDICAL DIRECTOR)
(301) 263-4890
Entity
Organization
Contact information
Practice address
216 CRAIN HWY N STE 102, GLEN BURNIE, MD 21061-3086
(301) 263-4890
Mailing address
216 CRAIN HWY N STE 102, GLEN BURNIE, MD 21061-3086
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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