MEDICARE: PIXIE CARES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427628791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIXIE CARES

Provider Business Mailing Address
First Line	:	2641 ASLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 ASHLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1646
Country	:	US
Telephone Number	:	410-808-0864
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEITH LEWIS
Credential	:
Telephone Number	:	410-809-0864

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	07/27/2021

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Directions to “PIXIE CARES ” Practice Location

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