Provider Demographics
NPI:1679379176
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:
Practice Address - Street 1:9800 PATUXENT WOODS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2948
Practice Address - Country:US
Practice Address - Phone:443-923-9200
Practice Address - Fax:667-205-4395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No281PC2000XHospitalsChronic Disease HospitalChildren
No282E00000XHospitalsLong Term Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No283X00000XHospitalsRehabilitation Hospital
No283XC2000XHospitalsRehabilitation HospitalChildren
No284300000XHospitalsSpecial Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD9Other.
MD59351301Other.
MD955675300Medicaid