Provider Demographics
NPI:1013467000
Name:JUDE'S PLACE LLC
Entity Type:Organization
Organization Name:JUDE'S PLACE LLC
Other - Org Name:JUDE'S PLACE CARE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:ACHE, BSCSM
Authorized Official - Phone:817-266-9626
Mailing Address - Street 1:13537 LOST SPURS RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-4508
Mailing Address - Country:US
Mailing Address - Phone:817-266-9626
Mailing Address - Fax:
Practice Address - Street 1:13537 LOST SPURS RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-4508
Practice Address - Country:US
Practice Address - Phone:817-266-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health