MEDICARE: MELWOOD, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	DDA-18945-07	MD
2	251C00000X	Developmentally Disabled Services Day Training Agency	DDA-18945-07	MD

General Provider Information

NPI Number	:	1407042765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELWOOD, INCORPORATED

Provider Business Mailing Address
First Line	:	5606 DOWER HOUSE RD
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3604
Country	:	US
Telephone Number	:	301-599-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 DOWER HOUSE RD
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3604
Country	:	US
Telephone Number	:	301-599-8000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	RON STUBBLEFIELD
Credential	:
Telephone Number	:	301-599-4511

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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Directions to “MELWOOD, INCORPORATED ” Practice Location

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