1154437879 NPI number — MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.

Table of content: (NPI 1154437879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154437879 NPI number — MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR HEALTH VISITING NURSE ASSOCIATION, 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:
Provider Other Organization Name Type Code:
6
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:
1154437879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6404 IVY LN STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-965-2900
Provider Business Mailing Address Fax Number:
240-965-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6404 IVY LN STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-965-2900
Provider Business Practice Location Address Fax Number:
240-965-2919
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON-ARAUJO
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
443-812-8131

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH7150 , 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: 044003500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028880900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 779 . This is a "CAREFIRST NASCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58469702 . This is a "BCBS OF MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 68972 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4971612 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 779 . This is a "BCBS NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 478204 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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