1437646882 NPI number — ASSOCIATED CATHOLIC CHARITIES, INC.

Table of content: RACHEL LABASAN VO DPT (NPI 1174395321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437646882 NPI number — ASSOCIATED CATHOLIC CHARITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED CATHOLIC CHARITIES, 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:
Provider Other Organization Name Type Code:
6
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:
1437646882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/03/2020
NPI Reactivation Date:
05/20/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 DULANEY VALLEY RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
667-600-2244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 CONTINENTAL DR STE 101&102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21009-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-600-3220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OVERSMITH
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
667-600-2249

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 419835212 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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