Healthcare Provider Details

I. General information

NPI: 1932915691
Provider Name (Legal Business Name): JPAT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 COUNTRY SKIES AVE
LAS VEGAS NV
89123-5308
US

IV. Provider business mailing address

1062 COUNTRY SKIES AVE
LAS VEGAS NV
89123
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-2969
  • Fax:
Mailing address:
  • Phone: 310-927-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON GRANT TOLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-927-2969