Provider Demographics
NPI:1295727485
Name:JENKINS MEMORIAL NURSING HOME INC
Entity type:Organization
Organization Name:JENKINS MEMORIAL NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:667-600-2601
Mailing Address - Street 1:3320 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1035
Mailing Address - Country:US
Mailing Address - Phone:410-644-7100
Mailing Address - Fax:410-644-2154
Practice Address - Street 1:3320 BENSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1035
Practice Address - Country:US
Practice Address - Phone:667-600-2600
Practice Address - Fax:667-600-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-032314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD300827400Medicaid
MD59017401OtherBLUE CROSS/BLUE SHIELD
MD300827400Medicaid