Provider Demographics
NPI:1528045986
Name:JOINT RETIREMENT CONVENT INC
Entity Type:Organization
Organization Name:JOINT RETIREMENT CONVENT INC
Other - Org Name:THE VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAICKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-377-2450
Mailing Address - Street 1:6806 BELLONA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1299
Mailing Address - Country:US
Mailing Address - Phone:410-377-2450
Mailing Address - Fax:410-377-2501
Practice Address - Street 1:6806 BELLONA AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1299
Practice Address - Country:US
Practice Address - Phone:410-377-2450
Practice Address - Fax:410-377-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-070313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510090900Medicaid
MD981503100Medicaid
MD215296Medicare ID - Type UnspecifiedMEDICARE A & B
MD981503100Medicaid