Provider Demographics
NPI:1942243696
Name:PEOPLES COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PEOPLES COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASSATT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-467-6040
Mailing Address - Street 1:2524 KIRK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4826
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:
Practice Address - Street 1:1300 N FULTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1528
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH649OtherCAREFIRST BLUE CROSS BLUE SHIELD OF MARYLAND
MD910561100Medicaid
MDH649OtherCAREFIRST BLUE CROSS BLUE SHIELD OF MARYLAND
MDH649Medicare PIN