Healthcare Provider Details

I. General information

NPI: 1043200652
Provider Name (Legal Business Name): SOUTHERN MARYLAND HOME HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10403 HOSPITAL DR SUITE G-09
CLINTON MD
20735-3134
US

IV. Provider business mailing address

10403 HOSPITAL DR SUITE G-09
CLINTON MD
20735-3134
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-3192
  • Fax: 301-856-0538
Mailing address:
  • Phone: 301-856-3192
  • Fax: 301-856-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH7077
License Number StateMD

VIII. Authorized Official

Name: MR. JEFFREY JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 301-856-3192