Provider Demographics
NPI:1043200652
Name:SOUTHERN MARYLAND HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-856-3192
Mailing Address - Street 1:10403 HOSPITAL DR
Mailing Address - Street 2:SUITE G-09
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:301-856-3192
Mailing Address - Fax:301-856-0538
Practice Address - Street 1:10403 HOSPITAL DR
Practice Address - Street 2:SUITE G-09
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3134
Practice Address - Country:US
Practice Address - Phone:301-856-3192
Practice Address - Fax:301-856-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7077251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD272763300Medicaid
MD217077Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER