Provider Demographics
NPI:1437497633
Name:ERICKSON LIVING HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ERICKSON LIVING HEALTH SERVICES, LLC
Other - Org Name:ERICKSON LIVING HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2323
Mailing Address - Street 1:21170 ASHBY PONDS BLVD
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6128
Mailing Address - Country:US
Mailing Address - Phone:703-723-1999
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:21170 ASHBY PONDS BLVD
Practice Address - Street 2:ATTN: OUTPATIENT ADMINISTRATOR
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6128
Practice Address - Country:US
Practice Address - Phone:703-723-1999
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496734Medicare Oscar/Certification