1255752770 NPI number — JKR ELDERCARE ENTERPRISES

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 1255752770 NPI number — JKR ELDERCARE ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JKR ELDERCARE ENTERPRISES
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:
6
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:
1255752770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 ALDEN VILLAGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27519-9793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-746-7050
Provider Business Mailing Address Fax Number:
919-788-1440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2245 GATEWAY ACCESS PT
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-746-7050
Provider Business Practice Location Address Fax Number:
919-788-1440
Provider Enumeration Date:
12/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JARRELL
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-746-7050

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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