MEDICARE: JENKINS MEMORIAL NURSING HOME INC

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	314000000X	Skilled Nursing Facility	30-032	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	59017401	OTHER	MD	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1295727485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENKINS MEMORIAL NURSING HOME INC

Provider Business Mailing Address
First Line	:	3320 BENSON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1035
Country	:	US
Telephone Number	:	410-644-7100
Fax Number	:	410-644-2154

Provider Business Practice Location Address
First Line	:	3320 BENSON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1035
Country	:	US
Telephone Number	:	667-600-2600
Fax Number	:	667-600-4035

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ZACHARY RICHARDS
Credential	:	NHA
Telephone Number	:	667-600-2601

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/03/2024

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