Provider Demographics
NPI:1093358376
Name:J & P INTEGRITY SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:J & P INTEGRITY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABALELO
Authorized Official - Middle Name:GAOLATLHE
Authorized Official - Last Name:TSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-251-8228
Mailing Address - Street 1:1915 HIGHWAY 36 W STE 11
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2709
Mailing Address - Country:US
Mailing Address - Phone:612-460-0527
Mailing Address - Fax:
Practice Address - Street 1:1915 HIGHWAY 36 W STE 11
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2709
Practice Address - Country:US
Practice Address - Phone:612-460-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services