| The House Of Jude Behavioral Health Services | |
|
420 E. 25th Street Baltimore MD 21218 | |
| (410) 705-1331 | |
| (410) 938-2237 |
| Full Name | The House Of Jude Behavioral Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 420 E. 25th Street, Baltimore, Maryland |
| Authorized Official Name and Position | Edith Augustson (OWNER) |
| Authorized Official Contact | 4107051331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The House Of Jude Behavioral Health Services P.o. Box 5004 Middle River MD 21220 Ph: (410) 705-1331 | The House Of Jude Behavioral Health Services 420 E. 25th Street Baltimore MD 21218 Ph: (410) 705-1331 |
| NPI Number | 1376701193 |
|---|---|
| Provider Enumeration Date | 05/29/2008 |
| Last Update Date | 05/03/2024 |
| Certification Date | 04/30/2024 |
| Medicare PECOS PAC ID | 2668813734 |
|---|---|
| Medicare Enrollment ID | O20240508000152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376701193 | NPI | - | NPPES |
| 414755300 | Medicaid | MD | |
| 411699201 | Medicaid | MD |
| Provider Name | Edith M Augustson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407888274 PECOS PAC ID: 7618318783 Enrollment ID: I20240520000380 |
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