Provider Demographics
NPI:1710336789
Name:JAJ HOME HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:JAJ HOME HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOROKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-435-0322
Mailing Address - Street 1:5919A YORK ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:410-435-0322
Mailing Address - Fax:410-435-0299
Practice Address - Street 1:5919A YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE CITY
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:410-435-0322
Practice Address - Fax:410-435-0299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAJ HOME HEALTHCARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1960261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412445600Medicaid