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General NPI Number Information
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NPI Number | 1902312101
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Entity Type | Organization
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Legal Business Name | JT PRIVATE DUTY HOME CARE, LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 27499 RIVERVIEW CENTER BLVD STE 207
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4334
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Country | US
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Telephone | 239-896-6582
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Fax | 239-645-4679
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Provider Business Mailing Address
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Address Line | 27499 RIVERVIEW CENTER BLVD
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN MORANO
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Credential |
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Telephone | 239-878-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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