Provider Demographics
NPI:1538507454
Name:MARYLAND TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:MARYLAND TREATMENT CENTERS, INC.
Other - Org Name:AVERY ROAD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONTRACTS MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:443-904-0145
Mailing Address - Street 1:14703 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3605
Mailing Address - Country:US
Mailing Address - Phone:301-762-5613
Mailing Address - Fax:301-762-3451
Practice Address - Street 1:14703 AVERY RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3605
Practice Address - Country:US
Practice Address - Phone:301-762-5613
Practice Address - Fax:301-762-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904818261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder