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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
261QP2300X
Primary Care Clinic/Center
261QR0400X
Rehabilitation Clinic/Center
Primary

Other

Enumeration date
07/17/2024
Last updated
07/17/2024
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