MEDICARE: ST JOSEPH COMMUNITY HEALTHCARE SERVICES

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1518609627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH COMMUNITY HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	11205 MELVIN CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-2039
Country	:	US
Telephone Number	:	301-708-8723
Fax Number	:

Provider Business Practice Location Address
First Line	:	11205 MELVIN CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-2039
Country	:	US
Telephone Number	:	301-708-8723
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARTINE ATANG
Credential	:
Telephone Number	:	301-708-8723

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	04/09/2022

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