Provider Demographics
NPI:1245405117
Name:JAIRE HOME, INC.
Entity Type:Organization
Organization Name:JAIRE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:ESTRELLA
Authorized Official - Last Name:RESURRECCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-240-7772
Mailing Address - Street 1:6945 E OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-5136
Mailing Address - Country:US
Mailing Address - Phone:714-240-7772
Mailing Address - Fax:
Practice Address - Street 1:10602 BORWICK ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6812
Practice Address - Country:US
Practice Address - Phone:562-866-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306003736320600000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities