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General NPI Number Information
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NPI Number | 1104535913
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Entity Type | Organization
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Legal Business Name | JJ GROUP
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 23232 PERALTA DR STE 216
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1438
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Country | US
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Telephone | 213-572-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 TURQUOISE CIR
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City | CHINO HILLS
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State | CA
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Zip | 91709-2158
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Country | US
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Telephone | 213-572-9909
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHILLA RADWANSKI
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Credential |
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Telephone | 213-572-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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