1700931177 NPI number — INSIGHT TREATMENT SERVICES

Table of content: (NPI 1700931177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700931177 NPI number — INSIGHT TREATMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT TREATMENT 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:
INSIGHT TREATMENT CENTERS
Provider Other Organization Name Type Code:
3
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:
1700931177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5210 AUTH RD STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUITLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20746-4354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-423-0967
Provider Business Mailing Address Fax Number:
301-909-1027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 NIAGARA RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20740-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-423-0967
Provider Business Practice Location Address Fax Number:
301-423-2750
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEADOWS
Authorized Official First Name:
RACHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
240-573-1594

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  903188 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 903188 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 03013 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X , with the licence number: 10088 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: G12271 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 904120 . This is a "SAMIS NO." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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