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Organization
ST. AGNES HEALTHCARE, INC.
Active
Organization
ST. AGNES HEALTHCARE, INC.
Active
Parent organization
ST. AGNES HEALTHCARE, INC.
Other names
St Agnes Diabetes Prevention Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. AGNES HEALTHCARE, INC.
Authorized official
EDWARD R LOVERN (PRESIDENT/CEO)
(667) 234-2105
Entity
Organization
Contact information
Practice address
900 CATON AVE, BALTIMORE, MD 21229-5201
(667) 234-3244
Mailing address
3585 WASHINGTON BLVD, HALETHORPE, MD 21227-1676
(667) 234-2149
(667) 234-8644
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
Primary
—
—
Other
Enumeration date
10/04/2019
Last updated
06/23/2021
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