Provider Demographics
NPI:1669269817
Name:MOUNT CARMEL HEALTHCARE LLC
Entity type:Organization
Organization Name:MOUNT CARMEL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDA
Authorized Official - Prefix:
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEVINYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-486-0152
Mailing Address - Street 1:1443 ROCK SPRING RD APT 2074
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1920
Mailing Address - Country:US
Mailing Address - Phone:443-486-0152
Mailing Address - Fax:410-943-2107
Practice Address - Street 1:119 LUCCA LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1477
Practice Address - Country:US
Practice Address - Phone:443-486-0152
Practice Address - Fax:410-943-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care