Healthcare Provider Details

I. General information

NPI: 1164734604
Provider Name (Legal Business Name): JEMISUN HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR SUITE 108
LAUREL MD
20707-5203
US

IV. Provider business mailing address

14201 LAUREL PARK DR SUITE 108
LAUREL MD
20707-5203
US

V. Phone/Fax

Practice location:
  • Phone: 301-879-2160
  • Fax: 301-684-5535
Mailing address:
  • Phone: 301-879-2160
  • Fax: 301-684-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberNSA-0120
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberNS0609006
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number040415100
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR2589
License Number StateMD

VIII. Authorized Official

Name: JUDITH NWAKANMA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-351-1329