Edcha Behavioral Health, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R229551 Issued in MD

Legal business name

EDCHA BEHAVIORAL HEALTH, LLC

Practice address

2670 Crain Hwy Ste 401
Waldorf, MD 20601-2818

Phone

(240) 419-2412

Fax

(240) 419-2495

NPI assigned

Dec 4, 2017

Organization subpart

No

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

Authorized official

Name

Edner Charles, CRNPNPI 1396171385

Title

CRNP/ Owner

Phone

(240) 419-2412

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edner Charles, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1396171385
  Medicare reassignment NPD Authorized official
• Marie Fayette Charles, CRNP-FNP-PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1376048348
  Medicare reassignment NPD

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512345600000",
    "number": "1245745918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 401",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012818",
            "telephone_number": "240-419-2412",
            "fax_number": "240-419-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 CRAIN HWY STE 401",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012818",
            "telephone_number": "240-419-2412",
            "fax_number": "240-419-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDCHA BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-04",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "EDNER",
        "authorized_official_title_or_position": "CRNP/ OWNER",
        "authorized_official_telephone_number": "240-419-2412",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R229551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.