Healthcare Provider Details

I. General information

NPI: 1447702840
Provider Name (Legal Business Name): CAROLE JENKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 STATE ST APT 1F.
ALBANY NY
12210-2132
US

IV. Provider business mailing address

248 STATE ST APT 1F.
ALBANY NY
12210-2132
US

V. Phone/Fax

Practice location:
  • Phone: 518-621-6626
  • Fax:
Mailing address:
  • Phone: 518-621-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number324373-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number324373-1
License Number StateNY

VIII. Authorized Official

Name: CAROLE ANN JENKS
Title or Position: LPN
Credential: LPN
Phone: 518-621-6626