MEDICARE: D & J PERSONAL CARE SERVICES

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	251E00000X	Home Health Agency	9205021-00	MD

General Provider Information

NPI Number	:	1568620771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D & J PERSONAL CARE SERVICES

Provider Business Mailing Address
First Line	:	1011 REVERDY RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-3224
Country	:	US
Telephone Number	:	410-905-7977
Fax Number	:	410-510-1648

Provider Business Practice Location Address
First Line	:	1011 REVERDY RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21212-3224
Country	:	US
Telephone Number	:	410-905-7977
Fax Number	:	410-510-1648

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAMES EDWARD BREAKFIELD
Credential	:
Telephone Number	:	410-905-7977

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	05/26/2008

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