MEDICARE: BALTIMORE CITY HEALTH START, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346494283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTIMORE CITY HEALTH START, LLC

Provider Business Mailing Address
First Line	:	2521 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4602
Country	:	US
Telephone Number	:	410-396-7318
Fax Number	:	410-366-2855

Provider Business Practice Location Address
First Line	:	2521 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4602
Country	:	US
Telephone Number	:	410-396-7318
Fax Number	:	410-366-2855

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CALVIN DAVID
Credential	:
Telephone Number	:	410-828-8100

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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Directions to “BALTIMORE CITY HEALTH START, LLC ” Practice Location

Language	Start Address	Practice Location

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