1730998733 NPI number — KENNEDY KRIEGER ASSOCIATES

Table of content: (NPI 1730998733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730998733 NPI number — KENNEDY KRIEGER ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY KRIEGER ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730998733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45944
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-5944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 ALICEANNA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-4387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-923-7500
Provider Business Practice Location Address Fax Number:
443-923-7505
Provider Enumeration Date:
01/03/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BADIE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
443-923-1812

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 168641100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: K631 . This is a "BLUECROSS MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F158 . This is a "BLUECROSS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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