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General NPI Number Information
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NPI Number | 1265628085
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Entity Type | Organization
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Legal Business Name | JEFFON SENIR CARE
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Dates
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Enumeration Date | 09/16/2007
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Last Update Date | 09/16/2007
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Provider Practice Location Address
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Address Line | 2620 BERRYWOOD LN
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City | SPRINGDALE
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State | MD
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Zip | 20774-7514
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Country | US
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Telephone | 240-770-7921
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 BERRYWOOD LN
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City | SPRINGDALE
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State | MD
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Zip | 20774-7514
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Country | US
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Telephone | 240-770-7921
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LUCAS N FON
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Credential |
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Telephone | 240-461-8569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 0609009
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 060909
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060909
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License Number State | MD
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