Provider Demographics
NPI:1497751135
Name:ADVENTIST HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTHCARE, INC.
Other - Org Name:ADVENTIST HEALTHCARE BEHAVIORAL HEALTH & WELLNESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER AND SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3030
Mailing Address - Street 1:820 W DIAMOND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1419
Mailing Address - Country:US
Mailing Address - Phone:301-315-3030
Mailing Address - Fax:
Practice Address - Street 1:14901 BROSCHART RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3318
Practice Address - Country:US
Practice Address - Phone:301-251-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD282NC2000X, 323P00000X
MD15039283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD299002400Medicaid
MD054542200Medicaid
MD214013Medicare Oscar/Certification