Healthcare Provider Details

I. General information

NPI: 1235596289
Provider Name (Legal Business Name): JNMJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N27W23957 PAUL RD STE 100
PEWAUKEE WI
53072-6223
US

IV. Provider business mailing address

N27W23957 PAUL RD STE 100
PEWAUKEE WI
53072-6223
US

V. Phone/Fax

Practice location:
  • Phone: 262-408-5873
  • Fax: 262-200-7027
Mailing address:
  • Phone: 262-408-5873
  • Fax: 262-200-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAHMOOD GOHAR
Title or Position: OWNER
Credential:
Phone: 262-408-5873