| Organization Name: | WALDEN SIERRA CORP |
| NPI Number: | 1326439894 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES WOOD (CFO) |
| Mailing Address: | 30007 Business Center Dr Charlotte Hall |
| State: | MD US |
| Postal Code: | 206223101 |
| Phone Number: | 8662390826 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2015 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 904527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |