Healthcare Provider Details

I. General information

NPI: 1780240572
Provider Name (Legal Business Name): JAI GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9708 ENNISKEEN AVE
LAS VEGAS NV
89129-8001
US

IV. Provider business mailing address

9708 ENNISKEEN AVE
LAS VEGAS NV
89129-8001
US

V. Phone/Fax

Practice location:
  • Phone: 702-793-5280
  • Fax:
Mailing address:
  • Phone: 702-793-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: ROY JUMAO AS JR.
Title or Position: OWNER/MEMBER
Credential:
Phone: 702-793-5280