Provider Demographics
NPI:1679024301
Name:ASSOCIATED CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:ASSOCIATED CATHOLIC CHARITIES
Other - Org Name:VILLA MARIA BEHAVIORAL HEALTH OF FREDERICK COUNTY-ADULT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE AND BILLING MAN
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
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4117
Mailing Address - Country:US
Mailing Address - Phone:667-600-2249
Mailing Address - Fax:410-561-7752
Practice Address - Street 1:111 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5403
Practice Address - Country:US
Practice Address - Phone:301-694-6654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health