Healthcare Provider Details

I. General information

NPI: 1205394111
Provider Name (Legal Business Name): JCL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E WILLIAM ST
DELAWARE OH
43015-2332
US

IV. Provider business mailing address

18 E WILLIAM ST
DELAWARE OH
43015-2332
US

V. Phone/Fax

Practice location:
  • Phone: 847-346-6946
  • Fax:
Mailing address:
  • Phone: 847-346-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MUNDWILER
Title or Position: OWNER
Credential: OTR/L
Phone: 847-346-6946