MEDICARE: PIKESVILLE HEALTH SERVICES 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	261QM2800X	Methadone Clinic	906136	MD
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	906136	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	899655	OTHER	MD	BEACON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457703993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKESVILLE HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	2833 SMITH AVE
Second Line	:	SUITE # 148
City	:	BALTIMORE
State	:	MD
Zip	:	21209-1426
Country	:	US
Telephone Number	:	410-415-6384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 GREENWOOD RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-3609
Country	:	US
Telephone Number	:	410-415-6384
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM SPONSOR
Name	:	AMIEL CHICHEPORTICHE
Credential	:	BS
Telephone Number	:	410-258-8939

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	11/26/2024

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Directions to “PIKESVILLE HEALTH SERVICES LLC ” Practice Location

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