Healthcare Provider Details

I. General information

NPI: 1720119944
Provider Name (Legal Business Name): JCORPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 MAIN ST
MOULTON AL
35650-1513
US

IV. Provider business mailing address

644 MAIN ST 644 MAIN ST
MOULTON AL
35650-1513
US

V. Phone/Fax

Practice location:
  • Phone: 256-974-9550
  • Fax: 256-974-7887
Mailing address:
  • Phone: 256-974-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS LASHUNDRA CRAIG
Title or Position: OWNER
Credential:
Phone: 256-974-9550