Healthcare Provider Details

I. General information

NPI: 1174141592
Provider Name (Legal Business Name): UPMC WESTERN MARYLAND CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 LESLIE LANE
CUMBERLAND MD
21502
US

IV. Provider business mailing address

12501 WILLOWBROOK RD FL 3
CUMBERLAND MD
21502-2506
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-7588
  • Fax: 240-362-7633
Mailing address:
  • Phone: 240-964-8342
  • Fax: 240-964-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMBER R RUBLE
Title or Position: SR. VICE PRESIDENT/CFO
Credential:
Phone: 240-964-8032