Healthcare Provider Details

I. General information

NPI: 1386283521
Provider Name (Legal Business Name): ERC MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SCHILLING RD STE AAND40B
HUNT VALLEY MD
21031-1104
US

IV. Provider business mailing address

7351 E. LOWRY BLVD SUITE 200
DENVER CO
80230
US

V. Phone/Fax

Practice location:
  • Phone: 303-731-8846
  • Fax:
Mailing address:
  • Phone: 303-731-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARINA SHEPEL
Title or Position: CONTRACTING AND CREDENTIALING MANAG
Credential:
Phone: 425-214-9321