Healthcare Provider Details

I. General information

NPI: 1417739699
Provider Name (Legal Business Name): JLC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E ROYALTON RD
BROADVIEW HEIGHTS OH
44147-2858
US

IV. Provider business mailing address

3201 E ROYALTON RD STE 30
BROADVIEW HEIGHTS OH
44147-2858
US

V. Phone/Fax

Practice location:
  • Phone: 330-687-0742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA LOVE
Title or Position: CLINICAL OVERSIGHT MANAGER
Credential:
Phone: 740-405-1036