| Mentor-maryland | |
|
1540 Caton Center Drive Halethorpe MD 21227 | |
| (410) 737-4200 | |
| Not Available |
| Full Name | Mentor-maryland |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1540 Caton Center Drive, Halethorpe, Maryland |
| Authorized Official Name and Position | Ivy Simmons (DIRECTOR OF OMHC) |
| Authorized Official Contact | 4104554600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor-maryland 5720 Executive Drive Catonsville MD 21228 Ph: (410) 455-4600 | Mentor-maryland 1540 Caton Center Drive Halethorpe MD 21227 Ph: (410) 737-4200 |
| NPI Number | 1588190748 |
|---|---|
| Provider Enumeration Date | 05/10/2017 |
| Last Update Date | 05/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588190748 | NPI | - | NPPES |
| 056668 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH-1757 (Maryland) | Primary |
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