Provider Demographics
NPI:1447747381
Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Other - Org Name:VILLA MARIA BEHAVIORAL HEALTH SERVICES OF BALTIMORE COUNTY TOWSON PRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-600-2249
Mailing Address - Street 1:1966 GREENSPRING DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4164
Mailing Address - Country:US
Mailing Address - Phone:667-600-2244
Mailing Address - Fax:
Practice Address - Street 1:1220 E JOPPA RD STE 332
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5811
Practice Address - Country:US
Practice Address - Phone:667-600-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419835213Medicaid