Healthcare Provider Details

I. General information

NPI: 1053801951
Provider Name (Legal Business Name): WINCHESTER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 BLOOMINGDALE RD
BALTIMORE MD
21216-3922
US

IV. Provider business mailing address

2833 SMITH AVE STE 148
BALTIMORE MD
21209-1426
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-8500
  • Fax:
Mailing address:
  • Phone: 410-624-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMIEL CHICHEPORTICHE
Title or Position: DIRECTOR
Credential:
Phone: 410-258-8939