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General NPI Number Information
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NPI Number | 1578013033
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Entity Type | Organization
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Legal Business Name | AJ CARE INC
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 10/09/2016
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Provider Practice Location Address
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Address Line | 11990 MELLOW CT
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-9127
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Country | US
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Telephone | 561-202-4048
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Fax |
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Provider Business Mailing Address
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Address Line | 11990 MELLOW CT
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-9127
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Country | US
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Telephone | 561-202-4048
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AZUCENA PREAGIDO JUMAPAO
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Credential | M.D.
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Telephone | 561-202-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | ME74493
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | ME74493
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License Number State | FL
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