Provider Demographics
NPI:1538355524
Name:MEADOW MOUNTAIN DRUG TREATMENT PROGRAM
Entity type:Organization
Organization Name:MEADOW MOUNTAIN DRUG TREATMENT PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:YOUTH CENTER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-895-5669
Mailing Address - Street 1:234 RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-2217
Mailing Address - Country:US
Mailing Address - Phone:301-895-5669
Mailing Address - Fax:301-895-3664
Practice Address - Street 1:234 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-2217
Practice Address - Country:US
Practice Address - Phone:301-895-5669
Practice Address - Fax:301-895-3664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND DEPARTMENT OF JUVENILE SEVERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149053245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD102113OtherSAMIS