=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215723986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K&J DOMESTIC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2025
-----------------------------------------------------
Last Update Date | 04/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 EASY GRUENE
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-0343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-336-5467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 EASY GRUENE
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-0343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-336-5467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MRS. KRISTINA LYNN LESSARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-336-5467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------