Provider Demographics
NPI:1962691170
Name:JUDAHCORP, INC
Entity type:Organization
Organization Name:JUDAHCORP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RRT, RPSGT
Authorized Official - Phone:575-763-4725
Mailing Address - Street 1:PO BOX 5250
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-5250
Mailing Address - Country:US
Mailing Address - Phone:575-763-4725
Mailing Address - Fax:575-763-4743
Practice Address - Street 1:1020 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4150
Practice Address - Country:US
Practice Address - Phone:575-763-4725
Practice Address - Fax:575-763-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic