Provider Demographics
NPI:1013554450
Name:DOUBLE K DOUBLE J
Entity Type:Organization
Organization Name:DOUBLE K DOUBLE J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-370-0303
Mailing Address - Street 1:171 E THOUSAND OAKS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5752
Mailing Address - Country:US
Mailing Address - Phone:805-370-0303
Mailing Address - Fax:
Practice Address - Street 1:171 E THOUSAND OAKS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5752
Practice Address - Country:US
Practice Address - Phone:805-370-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care