Provider Demographics
NPI:1174971865
Name:GENUINE QUEENS JCL CARE
Entity type:Organization
Organization Name:GENUINE QUEENS JCL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LKIENDRIA
Authorized Official - Middle Name:TRISCHUAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-649-5653
Mailing Address - Street 1:PO BOX 10306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-0306
Mailing Address - Country:US
Mailing Address - Phone:210-649-5653
Mailing Address - Fax:
Practice Address - Street 1:3730 S LOOP 1604 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78264-9551
Practice Address - Country:US
Practice Address - Phone:210-649-5653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization