Healthcare Provider Details

I. General information

NPI: 1841945631
Provider Name (Legal Business Name): MARIETTA HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CABIN CREEK DR
BURTONSVILLE MD
20866-1840
US

IV. Provider business mailing address

2901 CABIN CREEK DR
BURTONSVILLE MD
20866-1840
US

V. Phone/Fax

Practice location:
  • Phone: 301-256-4575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STELLA-MARIS ADAMU
Title or Position: CEO
Credential:
Phone: 301-256-4575