| Villa Maria At Light Street | |
|
1118 Light St Ste 200 Baltimore MD 21230-4152 | |
| (667) 600-2880 | |
| Not Available |
| Full Name | Villa Maria At Light Street |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1118 Light St Ste 200, Baltimore, Maryland |
| Authorized Official Name and Position | Gloria Reeves (A/R AND BILLING MANAGER) |
| Authorized Official Contact | 6676002249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Villa Maria At Light Street 2300 Dulaney Valley Rd Timonium MD 21093-2739 Ph: (667) 600-2249 | Villa Maria At Light Street 1118 Light St Ste 200 Baltimore MD 21230-4152 Ph: (667) 600-2880 |
| NPI Number | 1285890095 |
|---|---|
| Provider Enumeration Date | 07/31/2008 |
| Last Update Date | 01/03/2020 |
| Certification Date | 01/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285890095 | NPI | - | NPPES |
| 153800406 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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