Healthcare Provider Details

I. General information

NPI: 1710051156
Provider Name (Legal Business Name): JK REALESTATE INVESTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9718 LAKE RD
VAN LEAR KY
41265-8456
US

IV. Provider business mailing address

9718 LAKE RD
VAN LEAR KY
41265-8456
US

V. Phone/Fax

Practice location:
  • Phone: 606-889-8529
  • Fax:
Mailing address:
  • Phone: 606-889-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOYCE M IDLE
Title or Position: OWNER
Credential:
Phone: 606-889-8529