Provider Demographics
NPI:1194832261
Name:JEWISH SOCIAL SERVICE AGENCY
Entity Type:Organization
Organization Name:JEWISH SOCIAL SERVICE AGENCY
Other - Org Name:JEWISH SOCIAL SERVICE AGENCY - HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-816-2616
Mailing Address - Street 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4860
Mailing Address - Country:US
Mailing Address - Phone:301-881-3700
Mailing Address - Fax:301-770-3242
Practice Address - Street 1:6123 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4860
Practice Address - Country:US
Practice Address - Phone:301-881-3700
Practice Address - Fax:301-816-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1508104100000X, 163W00000X, 374U00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD585OtherBCBS OF MD
MD7800379OtherAETNA PPO
MD2948867OtherAETNA HMO
MD553235307Medicaid
MD100491OtherKAISER
MD585OtherBCBS OF MD