Healthcare Provider Details

I. General information

NPI: 1952965667
Provider Name (Legal Business Name): K & J CARE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 04/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S MAIN ST
CLINTON MO
64735-2620
US

IV. Provider business mailing address

PO BOX 9655
SPRINGFIELD MO
65801-9655
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-7412
  • Fax: 866-567-0791
Mailing address:
  • Phone: 417-773-1892
  • Fax: 866-567-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHY S MCCRARY
Title or Position: OWNER
Credential:
Phone: 417-773-1892