Healthcare Provider Details

I. General information

NPI: 1194832261
Provider Name (Legal Business Name): JEWISH SOCIAL SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6123 MONTROSE RD
ROCKVILLE MD
20852-4860
US

IV. Provider business mailing address

6123 MONTROSE RD
ROCKVILLE MD
20852-4860
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-3700
  • Fax: 301-816-2628
Mailing address:
  • Phone: 301-881-3700
  • Fax: 301-770-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberH1508
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberH1508
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberH1508
License Number StateMD

VIII. Authorized Official

Name: LYNN PONTON
Title or Position: DIRECTOR, PATIENT ACCOUNTS
Credential:
Phone: 301-816-2616