Provider Demographics
NPI:1427555705
Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Other - Org Name:VILLA MARIA BEHAVIORAL HEALTH OF FALLSTAFF - ADULT PRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:A/R AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-600-2249
Mailing Address - Street 1:2300 DULANEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2739
Mailing Address - Country:US
Mailing Address - Phone:667-600-2249
Mailing Address - Fax:667-600-4068
Practice Address - Street 1:6999 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1430
Practice Address - Country:US
Practice Address - Phone:667-600-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
MD261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419835215Medicaid