Healthcare Provider Details

I. General information

NPI: 1144911470
Provider Name (Legal Business Name): JP ENTERPRISE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 TENNESSEE ST
VALLEJO CA
94590-4654
US

IV. Provider business mailing address

1517 TENNESSEE ST
VALLEJO CA
94590-4654
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-2266
  • Fax: 707-552-2773
Mailing address:
  • Phone: 707-552-2266
  • Fax: 707-552-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RICHELLE OLETA BROWN
Title or Position: STAFF COORDINATOR
Credential:
Phone: 707-552-2266