Basic Information
| Provider Information | |||||||||
| NPI: | 1598826448 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST HOME HEALTH SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12041 BOURNEFIELD WAY | ||||||||
| Address2: | STE B | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209047907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015924400 | ||||||||
| FaxNumber: | 3015924450 | ||||||||
| Practice Location | |||||||||
| Address1: | 12041 BOURNEFIELD WAY | ||||||||
| Address2: | STE B | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209047907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015924400 | ||||||||
| FaxNumber: | 3015924450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | BALLENGER | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | DOMINIC | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3015924409 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HH7032 | MD | Y | Agencies | Home Health |
No ID Information.