1255701215 NPI number — AMERICAN CENTER FOR INTELLECTUAL AND DEVELOPMENTAL DISABILITIES IN MD

Table of content: (NPI 1255701215)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255701215 NPI number — AMERICAN CENTER FOR INTELLECTUAL AND DEVELOPMENTAL DISABILITIES IN MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:
AMERICAN CENTER FOR INTELLECTUAL AND DEVELOPMENTAL DISABILITIES IN MD

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:
1255701215

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
10/03/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8980 OLD ANNAPOLIS RD

Provider Second Line Business Mailing Address:
SUITE B

Provider Business Mailing Address City Name:
COLUMBIA

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
21045-2115

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
443-319-5010

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 THOMAS DR

Provider Second Line Business Practice Location Address:
SUITE D

Provider Business Practice Location Address City Name:
LAUREL

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20707-4700

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-377-0750

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
10/03/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATHEW

Authorized Official First Name:
JOSEPH

Authorized Official Middle Name:

Authorized Official Title or Position:
PRESIDENT

Authorized Official Telephone Number:
443-718-7031

Provider Taxonomy Codes

Taxonomy code: 251S00000X , with the licence number: 1658 1659 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .