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  7. NPI Record 1568761526

POOL OF BETHESDA COMMUNITY SERVICES, INC.
Complete NPI Record 1568761526
Intermediate Care Facility, Intellectual Disabilities in Beltsville, MD

NPI Status: Active since March 16, 2011

Contact Information

5020 SUNNYSIDE AVE STE 104
BELTSVILLE, MD
ZIP 20705
Phone: (301) 220-0628
Fax: (301) 220-0629

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Is Organization Subpart
  29. Parent Organization LBN
  30. Parent Organization TIN
  31. Authorized Official Name Prefix Text
  32. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1568761526. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1568761526
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 5020 SUNNYSIDE AVE STE 104
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address City Name: BELTSVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 207052307
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3012200628
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3012200629
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 5020 SUNNYSIDE AVE STE 104
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: BELTSVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MD
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 207052307
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3012200628
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3012200629
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/16/2011
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/16/2011
The date that a record was last updated or changed.
Authorized Official Last Name: KONNEH
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SUSAN
The first name of the authorized official.
Authorized Official Middle Name: N
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 3012200628
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 315P00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: Y
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Parent Organization LBN: FAWEMA ENTERPRISES, INC.
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: MRS.
Authorized Official Credential Text: RN