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General NPI Number Information
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NPI Number | 1578193801
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Entity Type | Organization
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Legal Business Name | JMK RESIDENTIAL FACILITY
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Dates
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Enumeration Date | 01/26/2020
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 1278 E 125TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3216
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Country | US
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Telephone | 310-756-3839
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Fax |
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Provider Business Mailing Address
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Address Line | 1278 E 125TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JEANETTE M KIDD
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Credential |
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Telephone | 310-756-3839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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