Provider Demographics
NPI:1760644835
Name:MARYLAND TREATMENT CENTERS INC
Entity Type:Organization
Organization Name:MARYLAND TREATMENT CENTERS INC
Other - Org Name:JOURNEYS ADOLESCENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-447-2361
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:301-294-4015
Practice Address - Fax:301-294-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15147261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD391090300Medicaid