Healthcare Provider Details

I. General information

NPI: 1497909972
Provider Name (Legal Business Name): JK4 ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 2ND AVE SUITE 123
DETROIT MI
48201-2658
US

IV. Provider business mailing address

8940 WORMER
REDFORD MI
48239-1230
US

V. Phone/Fax

Practice location:
  • Phone: 313-272-9401
  • Fax: 313-272-9402
Mailing address:
  • Phone: 313-272-9401
  • Fax: 313-272-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: JOYCE KENYON STALLINGS
Title or Position: DIRECTOR
Credential:
Phone: 313-272-9401