Healthcare Provider Details

I. General information

NPI: 1700539269
Provider Name (Legal Business Name): PIKESVILLE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 GREENWOOD RD
BALTIMORE MD
21208-3609
US

IV. Provider business mailing address

2833 SMITH AVE STE 148
BALTIMORE MD
21209-1426
US

V. Phone/Fax

Practice location:
  • Phone: 410-258-8939
  • Fax:
Mailing address:
  • Phone: 410-258-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMIEL CHICHEPORTICHE
Title or Position: PROGRAM SPONSOR
Credential:
Phone: 410-484-8500