1255700480 NPI number — ASSOCIATED CATHOLIC CHARITIES

Table of content: (NPI 1255700480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255700480 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:
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:
1255700480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2020
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:
606 CHERRY HILL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21225-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-585-0598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2015

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 , 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: 421153501 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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