NPIMap

Organization Active NPI

56 West Frederick Street Operations LLC

Doing business as Glade Valley Center

  • Physical Therapist
  • Walkersville, MD
National Provider Identifier
1407200884
Registry record updated Aug 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10015 Issued in MD
Legal business name
56 WEST FREDERICK STREET OPERATIONS LLC
Doing business as
Glade Valley Center
Practice address
56 W Frederick St
Walkersville, MD 21793-8254
Phone
(301) 898-4300
NPI assigned
Apr 21, 2016
Last updated
Aug 31, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2017

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

Authorized official

Name
Michael T. Berg
Title
Assistant Secretary
Phone
(505) 468-4752

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10015 MD Primary
Occupational Therapist 225X00000X 10015 MD

Addresses

Primary practice location

56 W Frederick St
Walkersville, MD 21793-8254

Mailing address

56 W Frederick St
Walkersville, MD 21793-8254
Phone (301) 898-4300

Other identifiers 1

IdentifierTypeStateIssuer
556222800MedicaidMD

Other names 1

  • Glade Valley Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
56 West Frederick Street 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": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504137600000",
    "number": "1407200884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 W FREDERICK ST",
            "city": "WALKERSVILLE",
            "state": "MD",
            "postal_code": "217938254",
            "telephone_number": "301-898-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 W FREDERICK ST",
            "city": "WALKERSVILLE",
            "state": "MD",
            "postal_code": "217938254",
            "telephone_number": "301-898-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "56 WEST FREDERICK STREET OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2017-08-31",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "10015",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "10015",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556222800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glade Valley Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walkersville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2017; 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.