Provider Demographics
NPI:1275062531
Name:JB HEALTHCARE LLC
Entity Type:Organization
Organization Name:JB HEALTHCARE LLC
Other - Org Name:PROVIDENT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:435-632-7130
Mailing Address - Street 1:1224 S RIVER RD STE B229
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8387
Mailing Address - Country:US
Mailing Address - Phone:435-632-7130
Mailing Address - Fax:
Practice Address - Street 1:1224 SOUTH RIVER ROAD SUITE B-229
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-632-7130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health