NPIMap

Organization Active NPI

Sheppard Pratt Health System, Inc

Doing business as Jefferson RTC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Jefferson, MD
National Provider Identifier
1255424164
Registry record updated Jan 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
10-018 Issued in MD
Legal business name
SHEPPARD PRATT HEALTH SYSTEM, INC
Doing business as
Jefferson RTC
Practice address
2940 Point of Rocks Rd.
Jefferson, MD 21755-0009
Phone
(301) 624-8400
Fax
(301) 624-8404
NPI assigned
Oct 2, 2006
Last updated
Jan 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Bonnie B. Katz
Title
VP, Corporate Business Development
Phone
(410) 938-3154

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 10-018 MD Primary

Addresses

Primary practice location

2940 Point of Rocks Rd.
Jefferson, MD 21755-0009

Mailing address

6501 N Charles St
Baltimore, MD 21204-6819
Phone (410) 938-3000

Other identifiers 1

IdentifierTypeStateIssuer
081505500MedicaidMD

Other names 1

  • Jefferson RTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sheppard Pratt Health System Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

2940 Point of Rocks Rd
Jefferson, MD 21755
Phone (240) 315-0200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232064000000",
    "number": "1255424164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046819",
            "telephone_number": "410-938-3000",
            "fax_number": "410-938-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 POINT OF ROCKS RD.",
            "city": "JEFFERSON",
            "state": "MD",
            "postal_code": "217550009",
            "telephone_number": "301-624-8400",
            "fax_number": "301-624-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPPARD PRATT HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2009-01-16",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "VP, CORPORATE BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "410-938-3154",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MD",
            "license": "10-018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081505500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson RTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.