MEDICARE: JKE ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1053160911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKE ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	3225 N POINT PKWY STE 103
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4726
Country	:	US
Telephone Number	:	804-334-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 N POINT PKWY STE 103
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4726
Country	:	US
Telephone Number	:	804-334-4448
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JARAIN ELLIS
Credential	:
Telephone Number	:	804-334-4448

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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