Provider Demographics
NPI:1154437879
Name:MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
Entity type:Organization
Organization Name:MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON-ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-812-8131
Mailing Address - Street 1:6404 IVY LN STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1416
Mailing Address - Country:US
Mailing Address - Phone:240-965-2900
Mailing Address - Fax:240-965-2919
Practice Address - Street 1:6404 IVY LN STE 110
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1416
Practice Address - Country:US
Practice Address - Phone:240-965-2900
Practice Address - Fax:240-965-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7150251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD044003500Medicaid
DC028880900Medicaid
779OtherCAREFIRST NASCO
58469702OtherBCBS OF MARYLAND
68972OtherAMERICAID
VA4971612Medicaid
779OtherBCBS NCA
478204OtherAETNA
58469702OtherBCBS OF MARYLAND