=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679301105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JLN HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2024
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1714 BROOKLINE AVE SW
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-345-8018
-----------------------------------------------------
Fax | 256-429-3326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 AUBURN ST
-----------------------------------------------------
City | TOWN CREEK
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35672-3945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-345-8018
-----------------------------------------------------
Fax | 256-429-3326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BOTSWANA MULLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-781-2447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------