1780038208 NPI number — JMAKE HEALTH CARE SERVICES LLC.

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 1780038208 NPI number — JMAKE HEALTH CARE SERVICES LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JMAKE HEALTH CARE SERVICES LLC.
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:
Provider Other Organization Name Type Code:
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:
1780038208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 INVERRARY BLVD
Provider Second Line Business Mailing Address:
STE # 400 C
Provider Business Mailing Address City Name:
LAUDERHILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-696-4919
Provider Business Mailing Address Fax Number:
954-284-6508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 INVERRARY BLVD
Provider Second Line Business Practice Location Address:
STE # 400 C
Provider Business Practice Location Address City Name:
LAUDERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33319-4382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-696-4919
Provider Business Practice Location Address Fax Number:
954-284-6508
Provider Enumeration Date:
04/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MCKNIGHT
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
OWNER/
Authorized Official Telephone Number:
954-696-4919

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018785000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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