Healthcare Provider Details

I. General information

NPI: 1730673047
Provider Name (Legal Business Name): GOLDEN JEMZ ADULT MEDICAL DAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 CAMBELL BLVD
NOTTINGHAM MD
21236
US

IV. Provider business mailing address

3116 PAPER MILL RD
PHOENIX MD
21131-1432
US

V. Phone/Fax

Practice location:
  • Phone: 443-824-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEMINA SAKA
Title or Position: DIRECTOR
Credential:
Phone: 443-824-8288