Provider Demographics
NPI:1316574833
Name:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.
Other - Org Name:EAF-LANHAM REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORD, PROV-FACILITY ENROLLMNT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:STANARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-816-7405
Mailing Address - Street 1:4400 FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4447
Mailing Address - Country:US
Mailing Address - Phone:301-341-3882
Mailing Address - Fax:
Practice Address - Street 1:4400 FORBES BLVD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4447
Practice Address - Country:US
Practice Address - Phone:301-341-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy