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General NPI Number Information
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NPI Number | 1497909972
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Entity Type | Organization
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Legal Business Name | JK4 ENTERPRISES, INC.
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 2727 2ND AVE SUITE 123
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City | DETROIT
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State | MI
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Zip | 48201-2658
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Country | US
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Telephone | 313-272-9401
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Fax | 313-272-9402
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Provider Business Mailing Address
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Address Line | 8940 WORMER
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City | REDFORD
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State | MI
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Zip | 48239-1230
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Country | US
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Telephone | 313-272-9401
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Fax | 313-272-9402
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOYCE KENYON STALLINGS
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Credential |
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Telephone | 313-272-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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