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General NPI Number Information
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NPI Number | 1679788566
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Entity Type | Organization
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Legal Business Name | J-J QUAL CARE HOME
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1306 S HUDSON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-3013
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Country | US
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Telephone | 323-939-3964
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Fax | 323-939-3964
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Provider Business Mailing Address
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Address Line | 2251 HILL DR
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City | LOS ANGELES
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State | CA
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Zip | 90041-1130
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Country | US
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Telephone | 323-478-1936
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Fax | 323-478-7044
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Authorized Official
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Title or Position | LICENSEE
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Name | MRS. JEAN TIMBOL
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Credential |
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Telephone | 323-478-1936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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