Healthcare Provider Details

I. General information

NPI: 1225587579
Provider Name (Legal Business Name): JTEK SOLUTIONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 MONTER AVE
LOUISVILLE OH
44641-2034
US

IV. Provider business mailing address

1328 MONTER AVE
LOUISVILLE OH
44641-2034
US

V. Phone/Fax

Practice location:
  • Phone: 330-324-4318
  • Fax: 330-875-5497
Mailing address:
  • Phone: 330-324-4318
  • Fax: 330-875-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH R CHEVRAUX
Title or Position: PRESIDENT
Credential: CSA, CHAMP, CEAC
Phone: 330-324-4318