Provider Demographics
NPI:1831220847
Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Entity type:Organization
Organization Name:ASSOCIATED CATHOLIC CHARITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ST ANN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-600-2681
Mailing Address - Street 1:2300 DULANEY VALLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2739
Mailing Address - Country:US
Mailing Address - Phone:667-600-2680
Mailing Address - Fax:
Practice Address - Street 1:3308 BENSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227
Practice Address - Country:US
Practice Address - Phone:410-646-6532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED CATHOLIC CHARITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12779251C00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201023200Medicaid