=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851615017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JPS HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2010
-----------------------------------------------------
Last Update Date | 03/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8116A HARFORD RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-310-1205
-----------------------------------------------------
Fax | 410-665-4412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8116 HARFORD ROAD
-----------------------------------------------------
City | PARKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-310-1205
-----------------------------------------------------
Fax | 410-665-4412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTARTOR
-----------------------------------------------------
Name | MISS VERONICA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-310-1205
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Pediatric Skilled Nursing Facility
-----------------------------------------------------
License Number | R2847
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------