Healthcare Provider Details

I. General information

NPI: 1689932147
Provider Name (Legal Business Name): WAY STATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W PATRICK ST
FREDERICK MD
21701
US

IV. Provider business mailing address

230 W PATRICK ST
FREDERICK MD
21701-6945
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0099
  • Fax: 301-695-2716
Mailing address:
  • Phone: 301-662-0099
  • Fax: 301-695-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SCOTT ROSE
Title or Position: CEO
Credential:
Phone: 301-662-0099