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General NPI Number Information
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NPI Number | 1902534050
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Entity Type | Organization
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Legal Business Name | JAC THREE, LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 11/27/2022
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Provider Practice Location Address
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Address Line | 6140 QUINWOOD LN N APT 4116
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City | PLYMOUTH
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State | MN
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Zip | 55442-1296
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Country | US
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Telephone | 952-484-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 13570 GROVE DR # 241
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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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 | OWNER
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Name | MARIA REHLANDER
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Credential |
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Telephone | 952-484-2179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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