=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144636796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JP HEALTH SYSTEMS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2014
-----------------------------------------------------
Last Update Date | 07/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3161 HILTON RD
-----------------------------------------------------
City | FERNDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48220-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-535-5685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6750 ALTA VISTA CT
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-535-5685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICK PETER KINAYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-535-5685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------