MEDICARE: JETD

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1275706020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JETD

Provider Business Mailing Address
First Line	:	1915 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5916
Country	:	US
Telephone Number	:	410-528-8730
Fax Number	:	410-528-8733

Provider Business Practice Location Address
First Line	:	1017 REISTERSTOWN RD
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-4207
Country	:	US
Telephone Number	:	410-580-9301
Fax Number	:	410-580-9305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH SHPARGA
Credential	:
Telephone Number	:	410-528-8730

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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Directions to “JETD ” Practice Location

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