MEDICARE: ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1295841781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC

Provider Business Mailing Address
First Line	:	12120 PLUM ORCHARD DR
Second Line	:	SUITE E
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7820
Country	:	US
Telephone Number	:	301-572-6585
Fax Number	:	301-572-5046

Provider Business Practice Location Address
First Line	:	12120 PLUM ORCHARD DR
Second Line	:	SUITE B
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7820
Country	:	US
Telephone Number	:	301-572-6585
Fax Number	:	301-572-5046

Authorized Official
Title or Position	:	CEO
Name	:	MR. FREDERIC B CHANTEAU
Credential	:
Telephone Number	:	301-572-6585

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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