Provider Demographics
NPI:1083896369
Name:JAECHELL'S ADULT FAMILY CARE HOME, INC.
Entity Type:Organization
Organization Name:JAECHELL'S ADULT FAMILY CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUISHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-687-8828
Mailing Address - Street 1:608 S LOIS CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3459
Mailing Address - Country:US
Mailing Address - Phone:561-687-8828
Mailing Address - Fax:
Practice Address - Street 1:608 S LOIS CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413-3459
Practice Address - Country:US
Practice Address - Phone:561-687-8828
Practice Address - Fax:561-687-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905994311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home