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General NPI Number Information
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NPI Number | 1972170082
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Entity Type | Organization
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Legal Business Name | JAX HOME HEALTH, INC
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 230 N MARYLAND AVE STE 301
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City | GLENDALE
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State | CA
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Zip | 91206-4281
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Country | US
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Telephone | 747-877-9240
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N MARYLAND AVE STE 301
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City | GLENDALE
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State | CA
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Zip | 91206-4281
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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 | JACQUELINE PANOSSIAN
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Credential |
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Telephone | 747-877-9240
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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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