1376611095 NPI number — JEWISH FOUNDATION FOR GROUP HOMES

Table of content: DR. MICHAEL WAYNE WARD PHARMD (NPI 1093026668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376611095 NPI number — JEWISH FOUNDATION FOR GROUP HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FOUNDATION FOR GROUP HOMES
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:
1376611095
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:
6010 EXECUTIVE BLVD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-984-3839
Provider Business Mailing Address Fax Number:
301-984-4219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2511 FREETOWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20191-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-453-0445
Provider Business Practice Location Address Fax Number:
703-453-0447
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-984-3839

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  317-01-001 , 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)





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