Provider Demographics
NPI:1730487703
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:AZUCENA
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-672-6758
Mailing Address - Street 1:401 HUNGERFORD DR # 6TH
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4154
Mailing Address - Country:US
Mailing Address - Phone:240-777-4520
Mailing Address - Fax:
Practice Address - Street 1:1301 PICCARD DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4320
Practice Address - Country:US
Practice Address - Phone:240-777-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP0905X
MD4782-06320800000X
MD22906261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420417400Medicaid