1538428339 NPI number — MARYLAND TREATMENT CENTERS, INC.

Table of content: (NPI 1538428339)

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 1538428339 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:

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:
1538428339

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
05/14/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 FREDERICK AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
BALTIMORE

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
21229-3618

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
410-233-1400

Provider Business Mailing Address Fax Number:
410-233-1666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LAWRENCE CT

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
ROCKVILLE

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20850-1523

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-251-8920

Provider Business Practice Location Address Fax Number:
301-251-8937

Provider Enumeration Date:
05/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAWYER

Authorized Official First Name:
RICHARD

Authorized Official Middle Name:

Authorized Official Title or Position:
DIRECTOR OF CONTRACTS MANAGEMENT

Authorized Official Telephone Number:
443-904-0145

Provider Taxonomy Codes

Taxonomy code: 261QR0405X , with the licence number: 904494 , 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: 904494 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .