1295714673 NPI number — J LOAM INC

Table of content: (NPI 1295714673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295714673 NPI number — J LOAM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J LOAM INC
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:
AT 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:
1295714673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2721 E. RUSSELL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-946-6666
Provider Business Mailing Address Fax Number:
702-946-6670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 E. RUSSEL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-946-6666
Provider Business Practice Location Address Fax Number:
702-946-6670
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TCRUZ
Authorized Official First Name:
ISABEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT & C.E.O
Authorized Official Telephone Number:
702-946-6666

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  3688HHA3 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100500696 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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