Provider Demographics
NPI:1982149571
Name:JECC HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JECC HEALTH ASSOCIATES, LLC
Other - Org Name:JES HEALTH ASSOCIATES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANDU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC, CR
Authorized Official - Phone:443-226-2459
Mailing Address - Street 1:8600 LASALLE ROAD
Mailing Address - Street 2:CHESTER BUILDING, SUITE 321 2ND FLOOR
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:443-226-2459
Mailing Address - Fax:
Practice Address - Street 1:8600 LASALLE ROAD
Practice Address - Street 2:CHESTER BUILDING, SUITE 321 2ND FLOOR
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:443-226-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR090124363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419384900Medicaid