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General NPI Number Information
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NPI Number | 1336748383
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Entity Type | Organization
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Legal Business Name | JJJ YAUT, LLC
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 4806 NY 52
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City | JEFFERSONVILLE
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State | NY
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Zip | 12748
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Country | US
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Telephone | 845-482-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 2357 60TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-2689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | JENNIFER GRAJALES
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Credential |
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Telephone | 347-988-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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