Provider Demographics
NPI:1568638567
Name:TUERK HOUSE, INC.
Entity Type:Organization
Organization Name:TUERK HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-233-0684
Mailing Address - Street 1:730 N ASHBURTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-4700
Mailing Address - Country:US
Mailing Address - Phone:410-233-0684
Mailing Address - Fax:410-233-8540
Practice Address - Street 1:730 N ASHBURTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4700
Practice Address - Country:US
Practice Address - Phone:410-233-0684
Practice Address - Fax:410-233-8540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUERK HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903441261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024102400Medicaid