=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174853097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JKS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2009
-----------------------------------------------------
Last Update Date | 12/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 BROAD ST SUITE 201
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-462-5777
-----------------------------------------------------
Fax | 732-462-0577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 BROAD ST SUITE 201
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-462-5777
-----------------------------------------------------
Fax | 732-462-0577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MRS. KATHLEEN SANDFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-462-5777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | HP0136500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HP0136500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0136500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------