1689723504 NPI number — ALCOHOL AND DRUG SERVICES

Table of content: (NPI 1689723504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689723504 NPI number — ALCOHOL AND DRUG SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCOHOL AND DRUG SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689723504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6245 LEESBURG PIKE
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22044-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-533-0180
Provider Business Mailing Address Fax Number:
703-532-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 LEESBURG PIKE
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22044-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-533-0180
Provider Business Practice Location Address Fax Number:
703-532-5809
Provider Enumeration Date:
01/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AYBAR
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
AUGUSTO
Authorized Official Title or Position:
SENIOR CLINICIAN
Authorized Official Telephone Number:
703-533-0180

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  0718000136 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)