Healthcare Provider Details

I. General information

NPI: 1154437879
Provider Name (Legal Business Name): MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 IVY LN STE 110
GREENBELT MD
20770-1416
US

IV. Provider business mailing address

6404 IVY LN STE 110
GREENBELT MD
20770-1416
US

V. Phone/Fax

Practice location:
  • Phone: 240-965-2900
  • Fax: 240-965-2919
Mailing address:
  • Phone: 240-965-2900
  • Fax: 240-965-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH7150
License Number StateMD

VIII. Authorized Official

Name: MS. TRACI K ANDERSON-ARAUJO
Title or Position: PRESIDENT
Credential:
Phone: 443-812-8131