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General NPI Number Information
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NPI Number | 1629916135
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Entity Type | Organization
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Legal Business Name | JAY'S PLACE RESIDENTIAL GROUP HOME
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 7897 MINE RUN RD
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City | HANOVER
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State | MD
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Zip | 21076
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Country | US
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Telephone | 833-857-5223
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Fax |
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Provider Business Mailing Address
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Address Line | 12530 FAIRWOOD PKWY STE 102
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City | BOWIE
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State | MD
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Zip | 20720-6357
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Country | US
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Telephone | 833-857-5223
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LATOYA BEARD
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Credential | BEARD
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Telephone | 443-883-5636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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