| Organization Name: | HOUSE OF JUDE CHILDRENS SERVICES |
| NPI Number: | 1033390174 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERRI MITCHELL (BILLING MANAGER) |
| Mailing Address: | 374 Shagbark Rd Middle River |
| State: | MD US |
| Postal Code: | 212203904 |
| Phone Number: | 4103251278 |
| Fax Number: | 4438360405 |
| NPI Enumeration Date: | 11/16/2007 |
| NPI Last Update Date: | 11/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |