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General NPI Number Information
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NPI Number | 1437783677
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Entity Type | Organization
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Legal Business Name | JLAB INC
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 10650 54TH STREET
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City | MIRA LOMA
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State | CA
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Zip | 91752-2231
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Country | US
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Telephone | 951-685-9000
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Fax | 951-685-9000
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Provider Business Mailing Address
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Address Line | 10650 54TH STREET
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City | MIRA LOMA
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State | CA
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Zip | 91752-2231
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Country | US
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Telephone | 951-685-9000
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Fax | 951-685-9000
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MRS. LILIBETH SAMSON
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Credential |
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Telephone | 951-264-7933
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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 |
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License Number State |
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