Provider Demographics
NPI:1326301763
Name:HILLANDALE MENTAL HEALTH ASSOCIATES LLC
Entity Type:Organization
Organization Name:HILLANDALE MENTAL HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GHISLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUGY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-431-2500
Mailing Address - Street 1:10230 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1400
Mailing Address - Country:US
Mailing Address - Phone:301-431-2500
Mailing Address - Fax:301-439-5927
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-431-2500
Practice Address - Fax:301-439-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0695OtherBLUE CROSS BLUE SHIELD
MD131181600Medicaid
MD260007226OtherRAILROAD MEDICARE
181035OtherMARYLAND MEDICARE
MD001786OtherVALUE OPTIONS