Provider Demographics
NPI:1053655639
Name:MONTGOMERY VILLAGE PAIN AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:MONTGOMERY VILLAGE PAIN AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESKEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-625-5390
Mailing Address - Street 1:19211 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE B-12
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5028
Mailing Address - Country:US
Mailing Address - Phone:240-477-5452
Mailing Address - Fax:
Practice Address - Street 1:19211 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE B-12
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5028
Practice Address - Country:US
Practice Address - Phone:240-477-5452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC HEALTHCARE ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-20
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain