Basic Information
| Provider Information | |||||||||
| NPI: | 1841615572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIMENSIONS HEALTHCARE ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUITLAND FAMILY HEALTH & WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207851189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183655 | ||||||||
| FaxNumber: | 3016183521 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 SILVER HILL RD | ||||||||
| Address2: | |||||||||
| City: | SUITLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207465215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016182273 | ||||||||
| FaxNumber: | 3016183697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2014 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | WALLINGTON | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | Y. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3016183655 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DIMENSIONS HEALTHCARE ASSOCIATES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 405690600 | 05 | MD | MEDICAID | 090782102 | 05 | MD | MEDICAID |