Basic Information
| Provider Information | |||||||||
| NPI: | 1093175408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARYLAND TREATMENT CENTERS, INC | ||||||||
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| OtherOrganizationName: | MOUNTAIN MANOR- SAFE PASSAGES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 KEYSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EMMITSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217278619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014472361 | ||||||||
| FaxNumber: | 3014473715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 CHEVERLY AVE | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207853125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017725174 | ||||||||
| FaxNumber: | 3017725647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROBY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3014472361 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 905876 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.