Provider Demographics
NPI:1013361914
Name:SUSAN'S HEART
Entity Type:Organization
Organization Name:SUSAN'S HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHIMERE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-805-9464
Mailing Address - Street 1:2446 N CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-805-9464
Mailing Address - Fax:810-413-5792
Practice Address - Street 1:2446 N CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-805-9464
Practice Address - Fax:810-413-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3816251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health