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General NPI Number Information
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NPI Number | 1013361914
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Entity Type | Organization
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Legal Business Name | SUSAN'S HEART
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Dates
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Enumeration Date | 04/17/2016
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 2446 N CHARLES STREET
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City | BALTIMORE
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State | MD
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Zip | 21218
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Country | US
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Telephone | 410-805-9464
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Fax | 810-413-5792
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Provider Business Mailing Address
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Address Line | 2446 N CHARLES STREET
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City | BALTIMORE
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State | MD
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Zip | 21218
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Country | US
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Telephone | 410-805-9464
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Fax | 810-413-5792
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | CHIMERE BECOTE
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Credential |
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Telephone | 410-805-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R3816
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License Number State | MD
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