Provider Demographics
NPI:1679520662
Name:RIDERWOOD VILLAGE, INC.
Entity Type:Organization
Organization Name:RIDERWOOD VILLAGE, INC.
Other - Org Name:OUTPATIENT REHABILITATION AGENCY AT RIDERWOOD VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2315
Mailing Address - Street 1:3140 GRACEFIELD ROAD
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1820
Mailing Address - Country:US
Mailing Address - Phone:301-572-1300
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:3120 GRACEFIELD ROAD
Practice Address - Street 2:ATTN: REHABILITATION MANAGER
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5810
Practice Address - Country:US
Practice Address - Phone:301-572-1300
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
216671Medicare Oscar/Certification