Healthcare Provider Details

I. General information

NPI: 1881800027
Provider Name (Legal Business Name): KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N. BROADWAY
BALTIMORE MD
21205
US

IV. Provider business mailing address

P.O. BOX 744865
ATLANTA GA
30374
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax: 443-923-9405
Mailing address:
  • Phone: 443-923-1886
  • Fax: 443-923-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number802
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number30-036
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number30-036
License Number StateMD

VIII. Authorized Official

Name: MR. MIKE J NEUMAN
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 443-923-1810