Provider Demographics
NPI:1104391317
Name:RYAN REHABILITATION LLC
Entity Type:Organization
Organization Name:RYAN REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-942-9773
Mailing Address - Street 1:19630 CLUB HOUSE RD STE 715
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3040
Mailing Address - Country:US
Mailing Address - Phone:301-258-7771
Mailing Address - Fax:301-258-9078
Practice Address - Street 1:7100 BALTIMORE AVE STE 105
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3652
Practice Address - Country:US
Practice Address - Phone:301-209-9200
Practice Address - Fax:301-209-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty