Provider Demographics
NPI:1891327607
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: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:MS,CAC-AD,NCAC-II
Authorized Official - Phone:410-489-3737
Mailing Address - Street 1:2480 ROXBURY MILLS RD STE 10
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 1:2480 ROXBURY MILLS RD STE 10
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9718
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:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD181018900Medicaid