Healthcare Provider Details

I. General information

NPI: 1073031746
Provider Name (Legal Business Name): J&K HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W OTTER RIDGE DR STE A
GOODE VA
24556-2000
US

IV. Provider business mailing address

101 W OTTER RIDGE DR STE A
GOODE VA
24556-2000
US

V. Phone/Fax

Practice location:
  • Phone: 434-401-9471
  • Fax:
Mailing address:
  • Phone: 434-401-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-181579
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCO-181579
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-181579
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN WILLIAM MOISA
Title or Position: DIRECTOR
Credential:
Phone: 434-401-9471