Provider Demographics
NPI:1962153387
Name:PINK HEART HEALTH SERVICES & ACADEMY LLC
Entity type:Organization
Organization Name:PINK HEART HEALTH SERVICES & ACADEMY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:CHANTEL
Authorized Official - Last Name:CULLY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:443-822-4439
Mailing Address - Street 1:1609 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1733
Mailing Address - Country:US
Mailing Address - Phone:443-822-4439
Mailing Address - Fax:
Practice Address - Street 1:1609 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1733
Practice Address - Country:US
Practice Address - Phone:410-212-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
No291U00000XLaboratoriesClinical Medical Laboratory