Provider Demographics
NPI:1487188769
Name:ASSOCIATED CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:ASSOCIATED CATHOLIC CHARITIES
Other - Org Name:VILLA MARIA COMMUNITY RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-608-1303
Mailing Address - Street 1:300 E OLDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3600
Mailing Address - Country:US
Mailing Address - Phone:301-777-8685
Mailing Address - Fax:301-777-8687
Practice Address - Street 1:300 E OLDTOWN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3600
Practice Address - Country:US
Practice Address - Phone:301-777-8685
Practice Address - Fax:301-777-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03138251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health