=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972354686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JSC HEALTHCARE AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2024
-----------------------------------------------------
Last Update Date | 03/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3825 47TH ST
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32967-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-243-5201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3825 47TH ST
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32967-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-243-5201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JITERRIA LIGHTNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-243-5201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------