Provider Demographics
NPI:1114498300
Name:WAY STATION, INC.
Entity Type:Organization
Organization Name:WAY STATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:ELCHIN
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:240-608-3464
Mailing Address - Fax:301-695-2716
Practice Address - Street 1:228 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6946
Practice Address - Country:US
Practice Address - Phone:301-662-0099
Practice Address - Fax:301-695-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicaid