Provider Demographics
NPI:1265628085
Name:JEFFON SENIR CARE
Entity type:Organization
Organization Name:JEFFON SENIR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:FON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-461-8569
Mailing Address - Street 1:2620 BERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7514
Mailing Address - Country:US
Mailing Address - Phone:240-770-7921
Mailing Address - Fax:
Practice Address - Street 1:2620 BERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-7514
Practice Address - Country:US
Practice Address - Phone:240-770-7921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0609009251J00000X
MD060909320800000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness