Provider Demographics
NPI:1003108234
Name:HEALTHWAYS
Entity Type:Organization
Organization Name:HEALTHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CCM
Authorized Official - Phone:202-744-3445
Mailing Address - Street 1:3209 CAPTAIN DEMENT DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-6044
Mailing Address - Country:US
Mailing Address - Phone:202-744-3445
Mailing Address - Fax:
Practice Address - Street 1:3209 CAPTAIN DEMENT DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-6044
Practice Address - Country:US
Practice Address - Phone:202-744-3445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165231163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty