Healthcare Provider Details

I. General information

NPI: 1104780410
Provider Name (Legal Business Name): J&K COMFORT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 3RD AVE SW
ISANTI MN
55040-7496
US

IV. Provider business mailing address

107 3RD AVE SW
ISANTI MN
55040-7496
US

V. Phone/Fax

Practice location:
  • Phone: 763-452-0248
  • Fax: 763-452-0206
Mailing address:
  • Phone: 763-452-0248
  • Fax: 763-452-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN NYABICHA
Title or Position: MANAGER
Credential:
Phone: 612-735-5559