Organization
PIKESVILLE HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIEL CHICHEPORTICHE BS (PROGRAM SPONSOR)
(410) 415-6384
Entity
Organization
Contact information
Practice address
1209 GREENWOOD RD, BALTIMORE, MD 21208
(410) 415-6384
Mailing address
2833 SMITHE AVE, SUITE # 148, BALTIMORE, MD 21209
(410) 415-6384
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
906136
MD
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
906136
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000351
—
MD
01
—
899655
BEACON
MD
Enumeration date
05/16/2016
Last updated
08/18/2016
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