Basic Information
| Provider Information | |||||||||
| NPI: | 1417326554 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST REHABILITATION HOSPITAL OF MARYLAND INC | ||||||||
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| OtherOrganizationName: | ADVENTIST HEALTHCARE REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 W DIAMOND AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208781419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013153030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9909 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208506361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408646000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2015 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 3013153030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 407075500 | 05 | MD | MEDICAID |