Healthcare Provider Details

I. General information

NPI: 1952555617
Provider Name (Legal Business Name): EASTER SEALS WALTER REED ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 16TH ST S
ARLINGTON VA
22204-4974
US

IV. Provider business mailing address

1420 SPRING ST
SILVER SPRING MD
20910-2701
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-0964
  • Fax: 301-576-5317
Mailing address:
  • Phone: 301-588-8700
  • Fax: 301-576-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED L WILSON
Title or Position: CFO
Credential:
Phone: 301-588-8700