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General NPI Number Information
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NPI Number | 1609698315
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Entity Type | Organization
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Legal Business Name | J & K ASSISTED LIVING II
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 256 BARBAROSSA RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-1809
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Country | US
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Telephone | 321-704-0053
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Fax | 321-345-4297
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Provider Business Mailing Address
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Address Line | 256 BARBAROSSA RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-1809
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Country | US
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Telephone | 321-704-0053
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Fax | 321-345-4297
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KETLIE ELIE
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Credential | ADMINISTRATOR
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Telephone | 321-704-0053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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