MEDICARE: J AND K HCS INC

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	232391	FL
2	385H00000X	Respite Care	232391	FL
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	232391	FL

General Provider Information

NPI Number	:	1376813139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J AND K HCS INC

Provider Business Mailing Address
First Line	:	3010 SW 114TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2114
Country	:	US
Telephone Number	:	786-216-2754
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 SW 114TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2114
Country	:	US
Telephone Number	:	786-216-2754
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN J GUTIERREZ
Credential	:
Telephone Number	:	786-216-2754

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/10/2012

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