Healthcare Provider Details

I. General information

NPI: 1467463752
Provider Name (Legal Business Name): J,K, & L, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 JAMES ST
BELLINGHAM WA
98225-4945
US

IV. Provider business mailing address

911 21ST ST
ANACORTES WA
98221-2513
US

V. Phone/Fax

Practice location:
  • Phone: 360-733-9161
  • Fax: 360-715-1948
Mailing address:
  • Phone: 360-293-7222
  • Fax: 360-293-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4113148
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4113148
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: JAMES K ROE
Title or Position: PRESIDENT
Credential:
Phone: 360-293-7222