MEDICARE: ASSOCIATED CATHOLIC CHARITIES, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992821771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED CATHOLIC CHARITIES, INC.

Provider Business Mailing Address
First Line	:	2300 DULANEY VALLEY RD
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-2739
Country	:	US
Telephone Number	:	667-600-2249
Fax Number	:	667-600-4068

Provider Business Practice Location Address
First Line	:	1220 E JOPPA RD STE 332
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5811
Country	:	US
Telephone Number	:	667-600-2331
Fax Number	:

Authorized Official
Title or Position	:	A/R AND BILLING MANAGER
Name	:	MRS. GLORIA REEVES
Credential	:
Telephone Number	:	667-600-2249

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/02/2020

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