=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689949489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J&M HOMECARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 03/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 CROW CANYON CT SUITE 105
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-1977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-552-6500
-----------------------------------------------------
Fax | 925-552-6589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 CROW CANYON CT SUITE 105
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-1977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-552-6500
-----------------------------------------------------
Fax | 925-552-6589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. VINING ERIC JENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-552-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------