Basic Information
| Provider Information | |||||||||
| NPI: | 1780171132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED CATHOLIC CHARITIES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VILLA MARIA BEHAVIORAL HEALTH SERVICES- FREDERICK ADULT PRP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1966 GREENSPRING DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210934164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676002244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W NINTH ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676003310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2018 | ||||||||
| LastUpdateDate: | 04/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | OVERSMITH | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6676002249 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.