Provider Demographics
NPI:1932917085
Name:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Entity type:Organization
Organization Name:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-923-1812
Mailing Address - Street 1:PO BOX 45944
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5944
Mailing Address - Country:US
Mailing Address - Phone:443-923-1886
Mailing Address - Fax:443-923-1875
Practice Address - Street 1:11830 W MARKET PL STE NQ
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2431
Practice Address - Country:US
Practice Address - Phone:443-923-9327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No284300000XHospitalsSpecial Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
No281PC2000XHospitalsChronic Disease HospitalChildren
No282E00000XHospitalsLong Term Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No283X00000XHospitalsRehabilitation Hospital
No283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD9OtherID
MD59351301OtherID
MD955675300Medicaid