Provider Demographics
NPI:1093041428
Name:DR JANI ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DR JANI ASSOCIATES, LLC
Other - Org Name:COMMUNITY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-334-6687
Mailing Address - Street 1:2013 NORTHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3677
Mailing Address - Country:US
Mailing Address - Phone:410-334-6687
Mailing Address - Fax:
Practice Address - Street 1:2013 NORTHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3677
Practice Address - Country:US
Practice Address - Phone:410-334-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216000500Medicaid