Provider Demographics
NPI:1255302774
Name:GLASS MENTAL HEALTH FOUNDATION INC
Entity Type:Organization
Organization Name:GLASS MENTAL HEALTH FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3398
Mailing Address - Street 1:401 E CORPORATE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6430
Mailing Address - Country:US
Mailing Address - Phone:214-379-3347
Mailing Address - Fax:214-379-3324
Practice Address - Street 1:2 W AYLESBURY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4101
Practice Address - Country:US
Practice Address - Phone:410-561-9591
Practice Address - Fax:410-560-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLASS MENTAL HEALTH FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13110261Q00000X
MD905032261Q00000X, 261QR0405X
MD261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD99241900Medicaid
MD099421900Medicaid