=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467062430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JCO AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2020
-----------------------------------------------------
Last Update Date | 08/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2283 JENKINTOWN RD
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-463-8098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2283 JENKINTOWN RD
-----------------------------------------------------
City | GLENSIDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-463-8098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JOSELYN CHRISTINE OHANNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-463-8093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------