Provider Demographics
NPI:1689937260
Name:GLASS HEALTH PROGRAMS, INC.
Entity Type:Organization
Organization Name:GLASS HEALTH PROGRAMS, INC.
Other - Org Name:MEDMARK TREATMENT CENTERS - BELCAMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3300
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:214-853-9018
Practice Address - Street 1:1361 BRASS MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEL CAMP
Practice Address - State:MD
Practice Address - Zip Code:21017
Practice Address - Country:US
Practice Address - Phone:410-273-9700
Practice Address - Fax:410-273-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101202251S00000X
MD261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019661780001Medicaid
MD39191306Medicaid
MD905637OtherLICENSE
MD403453800Medicaid