Provider Demographics
NPI:1760644835
Name:MARYLAND TREATMENT CENTERS INC
Entity type:Organization
Organization Name:MARYLAND TREATMENT CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOC DIR CONTRACTS
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3062
Mailing Address - Street 1:14703 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3605
Mailing Address - Country:US
Mailing Address - Phone:301-762-5613
Mailing Address - Fax:301-762-3451
Practice Address - Street 1:14703 AVERY RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3605
Practice Address - Country:US
Practice Address - Phone:301-294-4015
Practice Address - Fax:301-294-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15147261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD391090300Medicaid