1255752770 NPI number — JKR ELDERCARE ENTERPRISES

Table of content: (NPI 1255752770)

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:
SARAHCARE ADULT DAYCARE CENTER
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:
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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