Healthcare Provider Details

I. General information

NPI: 1427493386
Provider Name (Legal Business Name): JGSJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 N DR. MARTIN LUTHER KING JR DRIVE SUITE 105
MILWAUKEE WI
53212-2312
US

IV. Provider business mailing address

PO BOX 480036
CHARLOTTE NC
28269-5300
US

V. Phone/Fax

Practice location:
  • Phone: 414-399-3850
  • Fax: 414-755-0725
Mailing address:
  • Phone: 414-704-9031
  • Fax: 414-775-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY JOSEPH
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-975-2484