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NPI Code Detail

MEDICARE: JIRA, LLC

MEDICARE: JIRA, 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1770734618
Entity Type Code : Organization
Provider Name (Legal Business Name) : JIRA, LLC
Provider Business Mailing Address
First Line : 11373 WILLOW WOOD LN
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-3593
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4760 FASHION SQUARE BLVD
Second Line :
City : SAGINAW
State : MI
Zip : 48604-2620
Country : US
Telephone Number : 989-249-0241
Fax Number : 989-249-0195
Authorized Official
Title or Position : MEMBER
Name : JAMIN RUARK
Credential :
Telephone Number : 734-560-8956
Provider Enumeration Date : 10/09/2008
Last Update Date : 03/29/2011

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Directions to “JIRA, LLC ” Practice Location

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