MEDICARE: ADONNIS JAMAAL STEWART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1164259578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADONNIS JAMAAL STEWART

Provider Business Mailing Address
First Line	:	8212 BROOKTREE ST
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2928
Country	:	US
Telephone Number	:	202-834-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	8212 BROOKTREE ST
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2928
Country	:	US
Telephone Number	:	202-834-8172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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Directions to “ ADONNIS JAMAAL STEWART ” Practice Location

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