Provider Demographics
NPI:1790899524
Name:MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
Other - Org Name:MEDSTAR HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON-ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-812-8131
Mailing Address - Street 1:2301 BROADBIRCH DR STE C
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1966
Mailing Address - Country:US
Mailing Address - Phone:240-965-2900
Mailing Address - Fax:240-965-2919
Practice Address - Street 1:5233 KING AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4003
Practice Address - Country:US
Practice Address - Phone:410-933-2900
Practice Address - Fax:410-933-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7068251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC028880900Medicaid
VA4971612Medicaid
58469702OtherBCBS OF MARYLAND
58469702OtherCAREFIRST NASCO
779OtherBCBS NCA
478204OtherAETNA
68972OtherAMERICAID
MD044003500Medicaid
MD044003500Medicaid