Provider Demographics
NPI: | 1033264890 |
---|---|
Name: | JUDSON CENTER, INC. |
Entity Type: | Organization |
Organization Name: | JUDSON CENTER, INC. |
Other - Org Name: | DETROIT BAPTIST CHILDREN'S HOME |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOUT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, LLP |
Authorized Official - Phone: | 248-549-4339 |
Mailing Address - Street 1: | 4410 W 13 MILE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ROYAL OAK |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48073-6515 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-549-4339 |
Mailing Address - Fax: | 248-549-8955 |
Practice Address - Street 1: | 4410 W 13 MILE RD |
Practice Address - Street 2: | |
Practice Address - City: | ROYAL OAK |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48073-6515 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-549-4339 |
Practice Address - Fax: | 248-549-8955 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-24 |
Last Update Date: | 2023-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6772767 | 251B00000X |
MI | 6359520 | 251B00000X |
MI | 251C00000X, 251S00000X, 320600000X, 320700000X, 320800000X, 320900000X, 322D00000X, 385HR2060X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |