Provider Demographics
NPI:1053492934
Name:WAY STATION, INC.
Entity Type:Organization
Organization Name:WAY STATION, INC.
Other - Org Name:WAY STATION AT FREDERICK COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-662-0099
Mailing Address - Street 1:PO BOX 3826
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-3826
Mailing Address - Country:US
Mailing Address - Phone:301-662-0099
Mailing Address - Fax:301-662-1071
Practice Address - Street 1:230 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6945
Practice Address - Country:US
Practice Address - Phone:301-662-0099
Practice Address - Fax:301-662-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588931600Medicaid