Healthcare Provider Details

I. General information

NPI: 1295727485
Provider Name (Legal Business Name): JENKINS MEMORIAL NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 BENSON AVE
BALTIMORE MD
21227-1035
US

IV. Provider business mailing address

3320 BENSON AVE
BALTIMORE MD
21227-1035
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2600
  • Fax: 667-600-4035
Mailing address:
  • Phone: 410-644-7100
  • Fax: 410-644-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30-032
License Number StateMD

VIII. Authorized Official

Name: MR. ZACHARY RICHARDS
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 667-600-2601