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General NPI Number Information
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NPI Number | 1053172528
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Entity Type | Organization
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Legal Business Name | LKJ ENTERPRISE LLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 5704 MOUNT HOOD CT
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City | SACRAMENTO
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State | CA
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Zip | 95842-2203
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Country | US
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Telephone | 510-677-7024
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Fax |
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Provider Business Mailing Address
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Address Line | 22012 SEVILLA RD APT 112
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City | HAYWARD
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State | CA
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Zip | 94541-2745
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Country | US
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Telephone | 510-909-3180
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOPHIA BROOMFIELD
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Credential |
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Telephone | 510-909-3180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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