Provider Demographics
NPI:1225163520
Name:ADVENTIST SENIOR LIVING SERVICES
Entity Type:Organization
Organization Name:ADVENTIST SENIOR LIVING SERVICES
Other - Org Name:ADVENTIST DIALYSIS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CENTRAL BUSINESS OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARIZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3272
Mailing Address - Street 1:12325 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2957
Mailing Address - Country:US
Mailing Address - Phone:301-622-4200
Mailing Address - Fax:
Practice Address - Street 1:12325 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2957
Practice Address - Country:US
Practice Address - Phone:301-622-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408123400Medicaid
212586Medicare ID - Type UnspecifiedPROVIDER NUMBER