Provider Demographics
NPI:1891979845
Name:SUBURBAN HOSPITAL, INC
Entity Type:Organization
Organization Name:SUBURBAN HOSPITAL, INC
Other - Org Name:SUBURBAN HOSPITAL ADDICTION TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-896-2574
Mailing Address - Street 1:8600 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1422
Mailing Address - Country:US
Mailing Address - Phone:301-896-3100
Mailing Address - Fax:301-896-2477
Practice Address - Street 1:6410 ROCKLEDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1829
Practice Address - Country:US
Practice Address - Phone:301-896-6083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBURBAN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02194Medicare PIN