Healthcare Provider Details

I. General information

NPI: 1407042765
Provider Name (Legal Business Name): MELWOOD, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 DOWER HOUSE RD
UPPER MARLBORO MD
20772-3604
US

IV. Provider business mailing address

5606 DOWER HOUSE RD
UPPER MARLBORO MD
20772-3604
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-8000
  • Fax:
Mailing address:
  • Phone: 301-599-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberDDA-18945-07
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberDDA-18945-07
License Number StateMD

VIII. Authorized Official

Name: RON STUBBLEFIELD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 301-599-4511