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General NPI Number Information
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NPI Number | 1275891947
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Entity Type | Organization
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Legal Business Name | ARCHWAY STATION, INC.
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 121 MEMORIAL AVE
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City | CUMBERLAND
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State | MD
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Zip | 21502-4209
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Country | US
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Telephone | 301-724-2582
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Fax | 301-777-8020
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Provider Business Mailing Address
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Address Line | 121 MEMORIAL AVE
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City | CUMBERLAND
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State | MD
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Zip | 21502-4209
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Country | US
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Telephone | 301-724-2582
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Fax | 301-777-8020
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH PROGRAM DIRECTOR
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Name | STEPHANIE MOORE
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Credential |
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Telephone | 301-777-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH472
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License Number State | MD
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