Healthcare Provider Details

I. General information

NPI: 1780157065
Provider Name (Legal Business Name): JK ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CLARK AVE
PRICHARD AL
36610
US

IV. Provider business mailing address

PO BOX 10365
PRICHARD AL
36610-0365
US

V. Phone/Fax

Practice location:
  • Phone: 251-605-9372
  • Fax:
Mailing address:
  • Phone: 251-605-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH ANN JOHNSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 251-605-9372