Healthcare Provider Details

I. General information

NPI: 1609609635
Provider Name (Legal Business Name): JNK MANAGEMENT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 S 2420 W
SOUTH JORDAN UT
84095-8659
US

IV. Provider business mailing address

10718 S 2420 W
SOUTH JORDAN UT
84095-8659
US

V. Phone/Fax

Practice location:
  • Phone: 801-694-7071
  • Fax:
Mailing address:
  • Phone: 801-694-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NICKSON N KASUE
Title or Position: DIRECTOR
Credential: DIRECTOR
Phone: 801-694-7071