Provider Demographics
NPI: | 1477005387 |
---|---|
Name: | ROCK CREEK FOUNDATION |
Entity Type: | Organization |
Organization Name: | ROCK CREEK FOUNDATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AR MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VIVIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOLINA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-572-6585 |
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: | 12120 PLUM ORCHARD DR |
Practice Address - Street 2: | SUITE B |
Practice Address - City: | SILVER SPRING |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20904-7820 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-586-0900 |
Practice Address - Fax: | 301-586-0908 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | AFFILIATED SANTE GROUP |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2016-10-26 |
Last Update Date: | 2016-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 5559 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |