Provider Demographics
NPI:1730860784
Name:DANIELS FAMILY COMMUNITY HEALTHCARE LLC
Entity type:Organization
Organization Name:DANIELS FAMILY COMMUNITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ NP
Authorized Official - Prefix:
Authorized Official - First Name:KHYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-985-6615
Mailing Address - Street 1:9005 MARCELLA AVE
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3911
Mailing Address - Country:US
Mailing Address - Phone:443-985-6615
Mailing Address - Fax:
Practice Address - Street 1:3716 HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7639
Practice Address - Country:US
Practice Address - Phone:443-985-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty