Provider Demographics
NPI:1417038357
Name:MARYLAND TREATMENT CENTERS, INC.
Entity type:Organization
Organization Name:MARYLAND TREATMENT CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-447-2361
Mailing Address - Street 1:511 JERMOR LN STE 202-204
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6151
Mailing Address - Country:US
Mailing Address - Phone:410-876-2425
Mailing Address - Fax:410-840-9388
Practice Address - Street 1:511 JERMOR LN STE 202-204
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6151
Practice Address - Country:US
Practice Address - Phone:410-876-2425
Practice Address - Fax:410-840-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903866261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510126301Medicaid