1528558210 NPI number — JR HEALTHCARE ASSOCIATES, LLC

Table of content: (NPI 1528558210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528558210 NPI number — JR HEALTHCARE ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JR HEALTHCARE ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528558210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2310 N CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-5127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-844-4110
Provider Business Mailing Address Fax Number:
410-741-3008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-844-4110
Provider Business Practice Location Address Fax Number:
410-741-3008
Provider Enumeration Date:
05/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
LONETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
QA/PI CONSULTANT
Authorized Official Telephone Number:
410-500-1310

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  MH000831 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BH000830 . This is a "MARYLAND DEPARTMENT OF HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com