Provider Demographics
NPI:1720233323
Name:ADVENTIST HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTHCARE, INC.
Other - Org Name:AHC HEALTH AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:COMMUNITY HEALTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOZENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKRABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3132
Mailing Address - Street 1:820 W DIAMOND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1419
Mailing Address - Country:US
Mailing Address - Phone:301-315-3140
Mailing Address - Fax:301-315-3135
Practice Address - Street 1:1801 RESEARCH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3152
Practice Address - Country:US
Practice Address - Phone:301-315-3140
Practice Address - Fax:301-315-3135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15315251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD887316Medicare PIN