Healthcare Provider Details

I. General information

NPI: 1619964608
Provider Name (Legal Business Name): 4 JS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 JEFFORDS ST
CLEARWATER FL
33756-4560
US

IV. Provider business mailing address

1735 JEFFORDS ST
CLEARWATER FL
33756-4560
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-8558
  • Fax: 727-447-8558
Mailing address:
  • Phone: 727-447-8558
  • Fax: 727-447-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5034
License Number StateFL

VIII. Authorized Official

Name: MRS. NILDA F RIVERA
Title or Position: PRESIDENT
Credential: BSMT
Phone: 727-686-4223