Provider Demographics
NPI:1336428986
Name:SODEXO
Entity Type:Organization
Organization Name:SODEXO
Other - Org Name:SJMC
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASA
Authorized Official - Middle Name:KARIN
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LDN
Authorized Official - Phone:410-337-1043
Mailing Address - Street 1:9639 ALDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1847
Mailing Address - Country:US
Mailing Address - Phone:443-520-0418
Mailing Address - Fax:
Practice Address - Street 1:7601 OSLER DRIVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7508
Practice Address - Country:US
Practice Address - Phone:410-337-1043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2570282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital