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General NPI Number Information
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NPI Number | 1245514165
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Entity Type | Organization
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Legal Business Name | JCDH INCORPORATED
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 118 INGALLS ST
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City | GRAND ISLAND
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State | NE
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Zip | 68803-5725
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Country | US
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Telephone | 308-382-9066
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Fax | 308-395-8822
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Provider Business Mailing Address
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Address Line | 32 KUESTER LK
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8609
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Country | US
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Telephone | 308-382-5189
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Fax | 308-395-8822
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JOYCE ELAINE CANTRELL
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Credential | NURSING HOME ADMIN.
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Telephone | 308-382-9066
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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 | ALF095
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License Number State | NE
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