Healthcare Provider Details

I. General information

NPI: 1740252329
Provider Name (Legal Business Name): WALDEN SIERRA, INC. - COMPASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44863 ST ANDREWS CHURCH ROAD
CALIFORNIA MD
20619
US

IV. Provider business mailing address

30007 BUSINESS CENTER DR
CHARLOTTE HALL MD
20622-3101
US

V. Phone/Fax

Practice location:
  • Phone: 301-862-4212
  • Fax:
Mailing address:
  • Phone: 301-997-1300
  • Fax: 301-997-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number100902
License Number StateMD

VIII. Authorized Official

Name: MR. CHARLES D WOOD
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 301-997-1300