=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699045161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FTJOL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2011
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 BUTLER AVE SUITE 301
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-207-0755
-----------------------------------------------------
Fax | 717-207-0758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 BUTLER AVE SUITE 301
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-207-0755
-----------------------------------------------------
Fax | 717-207-0758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RYAN ROY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-207-0755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 20023601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------