MEDICARE: J-J QUAL CARE HOME

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1679788566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J-J QUAL CARE HOME

Provider Business Mailing Address
First Line	:	2251 HILL DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1130
Country	:	US
Telephone Number	:	323-478-1936
Fax Number	:	323-478-7044

Provider Business Practice Location Address
First Line	:	1306 S HUDSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3013
Country	:	US
Telephone Number	:	323-939-3964
Fax Number	:	323-939-3964

Authorized Official
Title or Position	:	LICENSEE
Name	:	MRS. JEAN TIMBOL
Credential	:
Telephone Number	:	323-478-1936

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	08/22/2020

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