Provider Demographics
NPI:1013348267
Name:AFFILIATED SANTE GROUP
Entity Type:Organization
Organization Name:AFFILIATED SANTE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-572-6585
Mailing Address - Street 1:12200 TECH RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1983
Mailing Address - Country:US
Mailing Address - Phone:301-787-5692
Mailing Address - Fax:
Practice Address - Street 1:4355 NICOLE DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4349
Practice Address - Country:US
Practice Address - Phone:301-429-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422027700Medicaid