=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720490584
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J AND J MEDICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2014
-----------------------------------------------------
Last Update Date | 05/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5020 SUNNYSIDE AVE SUITE 201
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-297-9208
-----------------------------------------------------
Fax | 240-297-9356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5020 SUNNYSIDE AVE SUITE 201
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-297-9208
-----------------------------------------------------
Fax | 240-297-9356
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | MR. ANTHONY MOHAMED KAIKAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-518-2638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R3539
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------