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General NPI Number Information
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NPI Number | 1548807431
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Entity Type | Organization
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Legal Business Name | JONESBORO WELLNESS LLC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1701 LATOURETTE LN
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City | JONESBORO
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State | AR
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Zip | 72404-0797
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Country | US
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Telephone | 718-838-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 362 E KENNEDY BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1434
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Country | US
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Telephone | 718-838-1500
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JACOB TAUB
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Credential |
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Telephone | 718-838-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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