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General NPI Number Information
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NPI Number | 1740376482
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Entity Type | Organization
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Legal Business Name | JACER CORPORATION
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE STE 1D03
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City | FT STEWART
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State | GA
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Zip | 31314-5611
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Country | US
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Telephone | 912-435-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 309 KUWE TRAIL
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-368-6252
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE/REPRESENTATIVE
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Name | MS. BRENDA SOHAN
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Credential |
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Telephone | 703-931-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN166963
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License Number State | GA
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