MEDICARE: JEFFON SENIR CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	0609009	MD
2	320800000X	Mental Illness Community Based Residential Treatment Facility	060909	MD
3	251E00000X	Home Health Agency	060909	MD

General Provider Information

NPI Number	:	1265628085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFON SENIR CARE

Provider Business Mailing Address
First Line	:	2620 BERRYWOOD LN
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774-7514
Country	:	US
Telephone Number	:	240-770-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 BERRYWOOD LN
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774-7514
Country	:	US
Telephone Number	:	240-770-7921
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LUCAS N FON
Credential	:
Telephone Number	:	240-461-8569

Provider Enumeration Date	:	09/16/2007
Last Update Date	:	09/16/2007

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