NPIMap

Organization Active NPI

Shady Grove Adventist Nursing & Rehabilitation Center Inc

  • Skilled Nursing Facility
  • Rockville, MD
National Provider Identifier
1043217219
Registry record updated Jan 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SHADY GROVE ADVENTIST NURSING & REHABILITATION CENTER INC
Practice address
9701 Medical Center Dr
Rockville, MD 20850-3326
Phone
(301) 315-1900
Fax
(301) 315-1901
NPI assigned
Jul 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard A Marizan
Title
Director, Central Business Office
Phone
(301) 315-3272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X MD Primary

Addresses

Primary practice location

9701 Medical Center Dr
Rockville, MD 20850-3326

Mailing address

9701 Medical Center Dr
Rockville, MD 20850-3326
Phone (301) 315-1900

Other identifiers 2

IdentifierTypeStateIssuer
158057400MedicaidMD
403480500MedicaidMD

Other names 1

  • SHADY GROVE NURSING AND REBAH CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
9701 Medical Center Drive Operations LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264464000000",
    "number": "1043217219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9701 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503326",
            "telephone_number": "301-315-1900",
            "fax_number": "301-315-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503326",
            "telephone_number": "301-315-1900",
            "fax_number": "301-315-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE ADVENTIST NURSING & REHABILITATION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-04",
        "last_updated": "2010-01-26",
        "status": "A",
        "authorized_official_last_name": "MARIZAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR, CENTRAL BUSINESS OFFICE",
        "authorized_official_telephone_number": "301-315-3272"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158057400",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403480500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHADY GROVE NURSING AND REBAH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.