Healthcare Provider Details

I. General information

NPI: 1275706020
Provider Name (Legal Business Name): JETD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 REISTERSTOWN RD
PIKESVILLE MD
21208-4207
US

IV. Provider business mailing address

1915 MARYLAND AVE
BALTIMORE MD
21218-5916
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-9301
  • Fax: 410-580-9305
Mailing address:
  • Phone: 410-528-8730
  • Fax: 410-528-8733

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: MR. JOSEPH SHPARGA
Title or Position: PRESIDENT
Credential:
Phone: 410-528-8730