Provider Demographics
NPI:1386196400
Name:ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC
Entity Type:Organization
Organization Name:ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR/AM
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-586-0900
Mailing Address - Street 1:12200 TECH RD
Mailing Address - Street 2:STE 330
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1983
Mailing Address - Country:US
Mailing Address - Phone:301-572-6585
Mailing Address - Fax:
Practice Address - Street 1:4355 NICOLE DR STE E
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4349
Practice Address - Country:US
Practice Address - Phone:301-586-0900
Practice Address - Fax:240-516-0391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFILIATED SANTE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2898251S00000X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health