Provider Demographics
NPI:1538700844
Name:EUTIERRIA HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:EUTIERRIA HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOKHIN-MOGILNAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-852-1020
Mailing Address - Street 1:203 BRYAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5958
Mailing Address - Country:US
Mailing Address - Phone:410-852-1020
Mailing Address - Fax:
Practice Address - Street 1:203 BRYAN WAY STE A
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-5958
Practice Address - Country:US
Practice Address - Phone:410-852-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD570114700Medicaid