Provider Demographics
NPI:1619549599
Name:HILDA'S PLACE BEHAVIORAL HEALTH ORGANIZATION
Entity Type:Organization
Organization Name:HILDA'S PLACE BEHAVIORAL HEALTH ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD, NCAC-II
Authorized Official - Phone:410-370-8544
Mailing Address - Street 1:2480 ROXBURY MILLS RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9718
Mailing Address - Country:US
Mailing Address - Phone:410-489-3737
Mailing Address - Fax:410-489-3738
Practice Address - Street 1:2314 EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1909
Practice Address - Country:US
Practice Address - Phone:410-489-3737
Practice Address - Fax:410-489-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness