Organization
PIKESVILLE HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIEL CHICHEPORTICHE (PROGRAM SPONSOR)
(410) 484-8500
Entity
Organization
Contact information
Practice address
1209 GREENWOOD RD, BALTIMORE, MD 21208-3609
(410) 484-8500
Mailing address
1209 GREENWOOD RD, BALTIMORE, MD 21208-3609
(410) 484-8500
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
906136
MD
261QM0850X
Adult Mental Health Clinic/Center
Primary
906136
MD
261QM2800X
Methadone Clinic
906136
MD
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
906136
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
899655
BEACON
MD
Enumeration date
01/05/2017
Last updated
01/05/2017
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