Provider Demographics
NPI:1154320711
Name:IJ-JENEIL INC
Entity Type:Organization
Organization Name:IJ-JENEIL INC
Other - Org Name:IDA-JOY SHOPPES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-2048
Mailing Address - Street 1:4630 RICHMOND RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5965
Mailing Address - Country:US
Mailing Address - Phone:216-831-2048
Mailing Address - Fax:216-831-1028
Practice Address - Street 1:4630 RICHMOND RD
Practice Address - Street 2:SUITE 265
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5965
Practice Address - Country:US
Practice Address - Phone:216-831-2048
Practice Address - Fax:216-831-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240055Medicaid
OH0240055Medicaid