1629023585 NPI number — JMJ THERAPEA CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629023585 NPI number — JMJ THERAPEA CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JMJ THERAPEA CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JMJ THERAPEA HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629023585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20955 PATHFINDER RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765-4045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-843-6485
Provider Business Mailing Address Fax Number:
909-843-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20955 PATHFINDER RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DIAMOND BAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91765-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-843-6485
Provider Business Practice Location Address Fax Number:
909-843-6548
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAOJOCO
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-843-6485

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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