Healthcare Provider Details

I. General information

NPI: 1134955859
Provider Name (Legal Business Name): ARCHWAY STATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E OAK ST
OAKLAND MD
21550-1802
US

IV. Provider business mailing address

45 QUEEN ST
CUMBERLAND MD
21502-4543
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-9126
  • Fax:
Mailing address:
  • Phone: 301-777-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MOORE
Title or Position: BEHAVIORAL HEALTH PROGRAM DIRECTOR
Credential:
Phone: 301-777-1700