Provider Demographics
NPI:1871949487
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:CONTRACTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3062
Mailing Address - Street 1:3800 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3618
Mailing Address - Country:US
Mailing Address - Phone:410-233-1400
Mailing Address - Fax:410-233-1666
Practice Address - Street 1:9701 KEYSVILLE RD
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-8619
Practice Address - Country:US
Practice Address - Phone:301-447-2360
Practice Address - Fax:301-447-3673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND TREATMENT CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13953324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13953OtherLICENSE