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General NPI Number Information
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NPI Number | 1619383536
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Entity Type | Organization
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Legal Business Name | JGL ENTERPRISES, INC.
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 15115 SW SEQUOIA PKWY STE 170
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City | PORTLAND
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State | OR
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Zip | 97224-7156
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Country | US
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Telephone | 503-616-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 19965 SW 58TH TER
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City | TUALATIN
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State | OR
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Zip | 97062-6844
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Country | US
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Telephone | 503-616-0460
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES R MYERS
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Credential | CEBS
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Telephone | 503-616-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 152232
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License Number State | OR
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