MEDICARE: J.L. FAMILY PARTNERSHIP, 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	320700000X	Physical Disabilities Residential Treatment Facility
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1265953541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.L. FAMILY PARTNERSHIP, LLC

Provider Business Mailing Address
First Line	:	11165 E ALAMEDA AVE APT 207
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-6477
Country	:	US
Telephone Number	:	216-313-0269
Fax Number	:

Provider Business Practice Location Address
First Line	:	11165 E ALAMEDA AVE APT 207
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-6477
Country	:	US
Telephone Number	:	216-313-0269
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRANDON JACKSON
Credential	:
Telephone Number	:	513-926-7781

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	07/21/2022

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