Basic Information
Provider Information
NPI: 1457711087
EntityType: 2
ReplacementNPI:  
OrganizationName: NATIONAL REHABILITATION HOSPITAL, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MEDSTAR NRH REHAB NETWORK @ HYATTSVILLE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20410 CENTURY BLVD
Address2: SUITE 215
City: GERMANTOWN
State: MD
PostalCode: 208741186
CountryCode: US
TelephoneNumber: 3015406140
FaxNumber:  
Practice Location
Address1: 6401 AMERICAN BOULEVARD
Address2: SUITE 204
City: HYATTSVILLE
State: MD
PostalCode: 20782
CountryCode: US
TelephoneNumber: 3015406140
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/24/2016
LastUpdateDate: 02/24/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BRICKLEY
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT AMBULATORY OPERATION
AuthorizedOfficialTelephone: 3015406140
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR0400X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation

No ID Information.


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