Provider Demographics
NPI:1164734604
Name:JEMISUN HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:JEMISUN HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-351-1329
Mailing Address - Street 1:14201 LAUREL PARK DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-879-2160
Mailing Address - Fax:301-684-5535
Practice Address - Street 1:14201 LAUREL PARK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-879-2160
Practice Address - Fax:301-684-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0120251J00000X
MDNS0609006251J00000X
DC040415100253Z00000X
MDR2589253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care