=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497314298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JT ENTERPRISES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2019
-----------------------------------------------------
Last Update Date | 09/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16869 WEST GREENFIELD AVENUE 1ST FLOOR
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-439-8616
-----------------------------------------------------
Fax | 262-649-3042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16869 WEST GREENFIELD AVENUE 1ST FLOOR
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-439-8616
-----------------------------------------------------
Fax | 262-649-3042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COLLEEN FOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-309-5119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------