Provider Demographics
| NPI: | 1508811936 |
|---|---|
| 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: | ASSOC DIR OF CONTRACTS |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | SARAH |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | BOLEK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 240-401-3062 |
| Mailing Address - Street 1: | 3800 FREDERICK AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BALTIMORE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21229-3618 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 410-233-1400 |
| Mailing Address - Fax: | 410-233-5583 |
| Practice Address - Street 1: | 3800 FREDERICK AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | BALTIMORE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21229-3618 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 410-233-1400 |
| Practice Address - Fax: | 410-233-5583 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-24 |
| Last Update Date: | 2025-10-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MD | 3799 | 251300000X |
| MD | 14077 | 261QM0801X, 261QM0855X, 261QM0850X |
| MD | 903139 | 261QR0405X |
| MD | 2084P0800X, 2084P0802X, 2084A0401X, 2084P0804X | |
| MD | 903143 | 261QR0405X |
| MD | 903140 | 3245S0500X, 324500000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 251300000X | Agencies | Local Education Agency (LEA) | Group - Single Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Single Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Single Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
| No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Single Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Single Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Single Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 090501100 | Medicaid | |
| MD | 203102700 | Medicaid | |
| MD | 510126302 | Medicaid | |
| MO | 774502800 | Medicaid | |
| MD | 039155700 | Medicaid | |
| MD | 391090301 | Medicaid |
