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NPI Code Detail

MEDICARE: JRT HEALTHCARE, INC.

MEDICARE: JRT HEALTHCARE, 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
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number : 1932607363
Entity Type Code : Organization
Provider Name (Legal Business Name) : JRT HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number : 208-677-9814
Provider Business Practice Location Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number : 208-677-9814
Authorized Official
Title or Position : TREASURER
Name : SOON BURNAM
Credential :
Telephone Number : 949-540-1249
Provider Enumeration Date : 01/31/2018
Last Update Date : 01/31/2018

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