Healthcare Provider Details

I. General information

NPI: 1093240012
Provider Name (Legal Business Name): JELANI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 QUESADA AVE
SAN FRANCISCO CA
94124-2334
US

IV. Provider business mailing address

1601 QUESADA AVE
SAN FRANCISCO CA
94124-2334
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-5977
  • Fax: 415-671-1042
Mailing address:
  • Phone: 415-822-5977
  • Fax: 415-671-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: ADONIA MIDDLETON
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 415-822-3260