Provider Demographics
NPI:1700539269
Name:PIKESVILLE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PIKESVILLE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICHEPORTICHE
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:410-258-8939
Mailing Address - Fax:
Practice Address - Street 1:1209 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3609
Practice Address - Country:US
Practice Address - Phone:410-258-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy