Provider Demographics
NPI:1275706020
Name:JETD
Entity Type:Organization
Organization Name:JETD
Other - Org Name:RENAISSANCE ADULT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHPARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-528-8730
Mailing Address - Street 1:1915 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5916
Mailing Address - Country:US
Mailing Address - Phone:410-528-8730
Mailing Address - Fax:410-528-8733
Practice Address - Street 1:1017 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4207
Practice Address - Country:US
Practice Address - Phone:410-580-9301
Practice Address - Fax:410-580-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care