Healthcare Provider Details

I. General information

NPI: 1871069799
Provider Name (Legal Business Name): GILCHRIST HOSPICE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST STE 4105
BALTIMORE MD
21204-6808
US

IV. Provider business mailing address

6701 N. CHARLES STREET S. CHAPMAN BUILDING, SUITE 102
BALTIMORE MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3184
  • Fax:
Mailing address:
  • Phone: 443-849-6775
  • Fax: 443-849-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MODDERMAN
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 443-849-8302