Provider Demographics
NPI:1033123880
Name:ADVENTIST HEALTHCARE, INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTHCARE, INC
Other - Org Name:CAPITAL CHOICE PATHOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-471-3427
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-1350
Mailing Address - Country:US
Mailing Address - Phone:240-471-3427
Mailing Address - Fax:240-471-3401
Practice Address - Street 1:12041 BOURNEFIELD WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7907
Practice Address - Country:US
Practice Address - Phone:240-471-3427
Practice Address - Fax:240-471-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D0649632291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2556057 00Medicaid
MDP001981611OtherRAILROAD
VA010141125Medicaid
MD2556057 00Medicaid