Provider Demographics
NPI:1083162390
Name:ARCHWAY STATION, INC.
Entity Type:Organization
Organization Name:ARCHWAY STATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RECKLEY-MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, DHA
Authorized Official - Phone:301-777-1700
Mailing Address - Street 1:408 N CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2204
Mailing Address - Country:US
Mailing Address - Phone:301-777-1700
Mailing Address - Fax:301-722-1209
Practice Address - Street 1:408 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2204
Practice Address - Country:US
Practice Address - Phone:301-777-1700
Practice Address - Fax:301-722-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4810261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588551500Medicaid
MD588551501Medicaid