Provider Demographics
NPI:1912302688
Name:JERSIRA SHINDOH
Entity type:Organization
Organization Name:JERSIRA SHINDOH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:MS
Authorized Official - First Name:JERSIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-520-3689
Mailing Address - Street 1:9873 GOOD LUCK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3230
Mailing Address - Country:US
Mailing Address - Phone:202-520-3689
Mailing Address - Fax:
Practice Address - Street 1:9873 GOOD LUCK RD APT 1
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3230
Practice Address - Country:US
Practice Address - Phone:202-520-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10975311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home