1215930011 NPI number — POTOMAC VALLEY NURSING FACILITIES INC.

Table of content: (NPI 1215930011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215930011 NPI number — POTOMAC VALLEY NURSING FACILITIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTOMAC VALLEY NURSING FACILITIES INC.
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:
POTOMAC VALLEY NURSING AND WELLNESS CENTER
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:
1215930011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 POTOMAC VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-762-0700
Provider Business Mailing Address Fax Number:
301-838-5103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 POTOMAC VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-762-0700
Provider Business Practice Location Address Fax Number:
301-838-5103
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOWDEN
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT AND ADMINISTRATOR
Authorized Official Telephone Number:
301-762-0700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0015024 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100110 . This is a "EVERCARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: RT8 . This is a "GHMSI AND BLUECHOICE PROV" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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