Healthcare Provider Details

I. General information

NPI: 1982191334
Provider Name (Legal Business Name): ASSOCIATED CATHOLIC CHARITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 BUSINESS PKWY S STE A
WESTMINSTER MD
21157-3004
US

IV. Provider business mailing address

1966 GREENSPRING DR STE 200
TIMONIUM MD
21093-4164
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2850
  • Fax:
Mailing address:
  • Phone: 667-600-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GLORIA OVERSMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 667-600-2249