1306893870 NPI number — MARYLAND TREATMENT CENTERS, INC.

Table of content: (NPI 1306893870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306893870 NPI number — MARYLAND TREATMENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND TREATMENT CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTAIN MANOR TREATMENT CENTER-EMMITSBURG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306893870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9701 KEYSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMITSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21727-8619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-447-2361
Provider Business Mailing Address Fax Number:
301-447-3673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9701 KEYSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMITSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21727-8619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-447-2361
Provider Business Practice Location Address Fax Number:
301-447-3673
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
310-447-2361

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A0401X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 903838 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 903838 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 775700000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039135200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 775700001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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