Provider Demographics
NPI:1285041616
Name:GREEN RIDGE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:GREEN RIDGE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-683-6202
Mailing Address - Street 1:610 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879
Mailing Address - Country:US
Mailing Address - Phone:240-683-6202
Mailing Address - Fax:240-683-6203
Practice Address - Street 1:12073 TECH RD
Practice Address - Street 2:SUITE A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:240-683-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00564592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC182421Medicare PIN