# ST. AGNES HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. AGNES HEALTHCARE, INC.
- **Other names:** St Agnes Diabetes Prevention Program
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780225326
- **Legal business name:** ST. AGNES HEALTHCARE, INC.
- **Authorized official:** EDWARD R LOVERN (PRESIDENT/CEO)
- **Authorized official phone:** (667) 234-2105

## Contact information

- **Practice address:** 900 CATON AVE, BALTIMORE, MD 21229-5201
- **Practice address phone:** (667) 234-3244
- **Mailing address:** 3585 WASHINGTON BLVD, HALETHORPE, MD 21227-1676
- **Mailing address phone:** (667) 234-2149
- **Mailing address fax:** (667) 234-8644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2019
- **Last updated:** 06/23/2021