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General NPI Number Information
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NPI Number | 1104101781
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Entity Type | Organization
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Legal Business Name | HEALTHWAYS
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 11 FAWN RIDGE CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-5654
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Country | US
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Telephone | 410-628-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 11 FAWN RIDGE CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-5654
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Country | US
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Telephone | 410-628-1258
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Fax |
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Authorized Official
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Title or Position | LOCAL RN CARE COORDINATORS
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Name | MICHELLE HERB
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Credential | RN
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Telephone | 410-628-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | R177713
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License Number State | MD
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