Basic Information
| Provider Information | |||||||||
| NPI: | 1134635253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVENTIST HEALTHCARE, INC. | ||||||||
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| OtherOrganizationName: | ADVENTIST HEALTHCARE BEHAVIORAL HEALTH & WELLNESS SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 W DIAMOND AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208781469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013153102 | ||||||||
| FaxNumber: | 3013096060 | ||||||||
| Practice Location | |||||||||
| Address1: | 14901 BROSCHART RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012514500 | ||||||||
| FaxNumber: | 3013096060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2017 | ||||||||
| LastUpdateDate: | 12/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 3013153030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 906283 | MD | Y | Hospital Units | Rehabilitation, Substance Use Disorder Unit |
No ID Information.