Active NPI
Potomac Healthcare Foundation, LTD
Doing business as Safe Harbor at Mountain Manor
- Substance Abuse Rehabilitation Facility
- Emmitsburg, MD
National Provider Identifier
1558318329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- 13332
- Legal business name
- POTOMAC HEALTHCARE FOUNDATION, LTD
- Doing business as
- Safe Harbor at Mountain Manor
- Practice address
- 9701 Keysville Rd
Emmitsburg, MD 21727-8619 - Phone
- (301) 447-2361
- Fax
- (301) 447-3673
- NPI assigned
- May 27, 2006
- Last updated
- Mar 15, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. William J Roby, MBA
- Title
- Executive Vice President
- Phone
- (301) 447-2361
Specialties & licenses 11
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | MD | ||
| Adult Mental Health Clinic/Center | 261QM0850X | MD | ||
| Substance Abuse Rehabilitation Facility | 324500000X | 13332 | MD | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | MD | ||
| Mental Health Counselor | 101YM0800X | MD | ||
| Professional Counselor | 101YP2500X | MD | ||
| Clinical Psychologist | 103TC0700X | MD | ||
| Clinical Social Worker | 1041C0700X | MD | ||
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | MD | ||
| Psychiatry Physician | 2084P0800X | MD | ||
| Addiction Psychiatry Physician | 2084P0802X | MD |
Addresses
Primary practice location
9701 Keysville Rd
Emmitsburg, MD 21727-8619
Mailing address
9701 Keysville Rd
Emmitsburg, MD 21727-8619
Phone (301) 447-2361
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 342200300 | Medicaid | MD |
Other names 1
- Safe Harbor at Mountain Manor
National Provider Directory
National Provider Directory- Tax ID family
- Potomac Healthcare Foundation LTD
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Substance Abuse Rehabilitation Facility
- Emmitsburg, MD
- NPI 1194238782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300147200000",
"number": "1558318329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9701 KEYSVILLE RD",
"city": "EMMITSBURG",
"state": "MD",
"postal_code": "217278619",
"telephone_number": "301-447-2361",
"fax_number": "301-447-3673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9701 KEYSVILLE RD",
"city": "EMMITSBURG",
"state": "MD",
"postal_code": "217278619",
"telephone_number": "301-447-2361",
"fax_number": "301-447-3673"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "POTOMAC HEALTHCARE FOUNDATION, LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-27",
"last_updated": "2011-03-15",
"status": "A",
"authorized_official_last_name": "ROBY",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
"authorized_official_telephone_number": "301-447-2361",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MBA"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "261QM0850X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Mental Health",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "MD",
"license": "13332",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MD",
"license": null,
"primary": false
},
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "MD",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "342200300",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Safe Harbor at Mountain Manor",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Emmitsburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.