Healthcare Provider Details

I. General information

NPI: 1760644835
Provider Name (Legal Business Name): MARYLAND TREATMENT CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14703 AVERY RD
ROCKVILLE MD
20853-3605
US

IV. Provider business mailing address

14703 AVERY RD
ROCKVILLE MD
20853-3605
US

V. Phone/Fax

Practice location:
  • Phone: 301-294-4015
  • Fax: 301-294-4017
Mailing address:
  • Phone: 301-762-5613
  • Fax: 301-762-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number15147
License Number StateMD

VIII. Authorized Official

Name: MS. SARAH D BOLEK
Title or Position: ASSOC DIR CONTRACTS
Credential:
Phone: 240-401-3062