Basic Information
| Provider Information | |||||||||
| NPI: | 1306413315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED CATHOLIC CHARITIES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 VIRGINIA AVE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215024559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676002118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 N DUNDALK AVE | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212224221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676003681 | ||||||||
| FaxNumber: | 6676004093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | SERFASS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6676002118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
No ID Information.