MEDICARE: FJNR 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	174200000X	Meals Provider

General Provider Information

NPI Number	:	1417880832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FJNR LLC

Provider Business Mailing Address
First Line	:	3990 SW 40TH AVE
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-6224
Country	:	US
Telephone Number	:	786-487-1009
Fax Number	:	786-487-1009

Provider Business Practice Location Address
First Line	:	3990 SW 40TH AVE
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-6224
Country	:	US
Telephone Number	:	786-487-1009
Fax Number	:	786-487-1009

Authorized Official
Title or Position	:	OWNER
Name	:	JENNY DOREUS
Credential	:
Telephone Number	:	786-487-1009

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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