MEDICARE: PINK HEART HEALTH SERVICES & ACADEMY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	291U00000X	Clinical Medical Laboratory
3	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1962153387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK HEART HEALTH SERVICES & ACADEMY LLC

Provider Business Mailing Address
First Line	:	1609 CAMBRIDGE RD
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-1733
Country	:	US
Telephone Number	:	443-822-4439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 CAMBRIDGE RD
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-1733
Country	:	US
Telephone Number	:	410-212-0392
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DOMINIQUE CHANTEL CULLY
Credential	:	BSN RN
Telephone Number	:	443-822-4439

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	02/13/2022

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