1750547568 NPI number — ASSOCIATED CATHOLIC CHARITIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750547568 NPI number — ASSOCIATED CATHOLIC CHARITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED CATHOLIC CHARITIES
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:
VILLA MARIA AT LIGHT STREET
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:
1750547568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 DULANEY VALLEY RD
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:
667-600-2249
Provider Business Mailing Address Fax Number:
667-600-4068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1118 LIGHT ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-600-2880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
A/R AND 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: 110171417 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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