Healthcare Provider Details

I. General information

NPI: 1649505512
Provider Name (Legal Business Name): J & K IN-HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NAAS PL
DAYTON OH
45404-2054
US

IV. Provider business mailing address

12 NAAS PL
DAYTON OH
45404-2054
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-1635
  • Fax: 937-223-1503
Mailing address:
  • Phone: 937-223-1635
  • Fax: 937-223-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RITA M PRIKKEL
Title or Position: PRESIDENT
Credential: MLPN/GT
Phone: 937-223-1635