MEDICARE: HILDA'S PLACE BEHAVIORAL HEALTH ORGANIZATION,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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1649937632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILDA'S PLACE BEHAVIORAL HEALTH ORGANIZATION,INC

Provider Business Mailing Address
First Line	:	2480 ROXBURY MILLS RD STE 10
Second Line	:
City	:	GLENWOOD
State	:	MD
Zip	:	21738-9718
Country	:	US
Telephone Number	:	410-489-3737
Fax Number	:	410-489-3738

Provider Business Practice Location Address
First Line	:	3217 BERT KOONTZ RD
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-1603
Country	:	US
Telephone Number	:	410-489-3737
Fax Number	:	410-489-3738

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	THERESA THOMAS
Credential	:	CAC-AD, NCAC-II
Telephone Number	:	410-370-8544

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	11/24/2021

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