Provider Demographics
NPI:1558086587
Name:ASBURY ATLANTIC, INC
Entity Type:Organization
Organization Name:ASBURY ATLANTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL & COMPLIANCE PROGRAM COORD.
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-250-2105
Mailing Address - Street 1:5285 WESTVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8521
Mailing Address - Country:US
Mailing Address - Phone:301-250-2105
Mailing Address - Fax:
Practice Address - Street 1:301 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2807
Practice Address - Country:US
Practice Address - Phone:301-250-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD790008200Medicaid