Basic Information
| Provider Information | |||||||||
| NPI: | 1821461310 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARYLAND TREATMENT CENTERS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AVERY HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 KEYSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | EMMITSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217278619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014472361 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14705 AVERY HOUSE | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017625613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | SAWYER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACTS MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4439040145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.