Healthcare Provider Details

I. General information

NPI: 1932813896
Provider Name (Legal Business Name): JMI VENTURES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21709 RODAX ST
CANOGA PARK CA
91304-2536
US

IV. Provider business mailing address

21709 RODAX ST
CANOGA PARK CA
91304-2536
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-6870
  • Fax:
Mailing address:
  • Phone: 818-325-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY ILLENBERGER
Title or Position: LICENSEE
Credential:
Phone: 818-325-6870