Healthcare Provider Details

I. General information

NPI: 1780164087
Provider Name (Legal Business Name): RYAN REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19630 CLUB HOUSE RD STE 715
MONTGOMERY VILLAGE MD
20886
US

IV. Provider business mailing address

19630 CLUB HOUSE RD STE 715
MONTGOMERY VILLAGE MD
20886-3040
US

V. Phone/Fax

Practice location:
  • Phone: 301-258-7771
  • Fax: 301-258-9078
Mailing address:
  • Phone: 301-258-7771
  • Fax: 301-257-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELANIE SUTHARD
Title or Position: BILLING MANAGER
Credential:
Phone: 301-942-9773