Provider Demographics
NPI:1316373673
Name:ALFREDHOUSE IV
Entity type:Organization
Organization Name:ALFREDHOUSE IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:ALFRED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-260-2080
Mailing Address - Street 1:18100 CASHELL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1031
Mailing Address - Country:US
Mailing Address - Phone:301-260-2080
Mailing Address - Fax:
Practice Address - Street 1:14519 MANOR PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-1956
Practice Address - Country:US
Practice Address - Phone:301-260-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALFREDHOUSE ELDERCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL149-H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility