Basic Information
| Provider Information | |||||||||
| NPI: | 1215930011 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | POTOMAC VALLEY NURSING FACILITIES INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | POTOMAC VALLEY NURSING AND WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 POTOMAC VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208502757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017620700 | ||||||||
| FaxNumber: | 3018385103 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 POTOMAC VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208502757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017620700 | ||||||||
| FaxNumber: | 3018385103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOWDEN | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3017620700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, LNHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0015024 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7100110 | 01 | EVERCARE PROVIDER NUMBER | OTHER | RT8 | 01 | MD | GHMSI AND BLUECHOICE PROV | OTHER |