Provider Demographics
NPI:1932334406
Name:VICTOR CULLEN CENTER
Entity type:Organization
Organization Name:VICTOR CULLEN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:AD-CAC
Authorized Official - Phone:301-777-2145
Mailing Address - Street 1:6000 CULLEN DR
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9701
Mailing Address - Country:US
Mailing Address - Phone:301-739-8122
Mailing Address - Fax:301-739-7574
Practice Address - Street 1:6000 CULLEN DR
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780-9701
Practice Address - Country:US
Practice Address - Phone:301-739-8122
Practice Address - Fax:301-739-7574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MARYLAND DEPARTMENT OF JUVENILE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children