Provider Demographics
NPI:1033390174
Name:HOUSE OF JUDE CHILDRENS SERVICES
Entity Type:Organization
Organization Name:HOUSE OF JUDE CHILDRENS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-325-1278
Mailing Address - Street 1:PO BOX 9564
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-0564
Mailing Address - Country:US
Mailing Address - Phone:410-325-1278
Mailing Address - Fax:443-836-0405
Practice Address - Street 1:374 SHAGBARK RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3904
Practice Address - Country:US
Practice Address - Phone:410-325-1278
Practice Address - Fax:443-836-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)