Healthcare Provider Details

I. General information

NPI: 1427694595
Provider Name (Legal Business Name): JANET'S ENTERPRISE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 W 9TH ST
UPLAND CA
91786-4576
US

IV. Provider business mailing address

904 W 9TH ST
UPLAND CA
91786-4576
US

V. Phone/Fax

Practice location:
  • Phone: 951-545-4462
  • Fax: 909-577-0111
Mailing address:
  • Phone: 951-545-4462
  • Fax: 909-577-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN J HAYWOOD
Title or Position: OWNER
Credential:
Phone: 951-545-4462