Provider Demographics
NPI:1659861607
Name:WINCHESTER HEALTH LLC
Entity Type:Organization
Organization Name:WINCHESTER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINCHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-8500
Mailing Address - Street 1:2833 SMITH AVE STE 148
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1426
Mailing Address - Country:US
Mailing Address - Phone:410-624-7111
Mailing Address - Fax:
Practice Address - Street 1:1315 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3922
Practice Address - Country:US
Practice Address - Phone:410-484-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH001216Medicaid