Provider Demographics
NPI:1417556077
Name:MARYLAND TREATMENT CENTERS INC
Entity Type:Organization
Organization Name:MARYLAND TREATMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGEMENT
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 1:7281 MARCIES CHOICE LN FL 2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8329
Practice Address - Country:US
Practice Address - Phone:301-750-0017
Practice Address - Fax:301-804-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center