Healthcare Provider Details

I. General information

NPI: 1073088720
Provider Name (Legal Business Name): JMDK HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7177 BROCKTON AVE STE 108
RIVERSIDE CA
92506-2632
US

IV. Provider business mailing address

7177 BROCKTON AVE STE 108
RIVERSIDE CA
92506-2632
US

V. Phone/Fax

Practice location:
  • Phone: 800-200-7177
  • Fax: 909-219-9939
Mailing address:
  • Phone: 800-200-7177
  • Fax: 909-219-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LAMBERTO VALIENTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 800-200-7177