Provider Demographics
NPI:1336319730
Name:NKAJ INTERPRISES LLC
Entity Type:Organization
Organization Name:NKAJ INTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:432-816-6871
Mailing Address - Street 1:3245 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-3516
Mailing Address - Country:US
Mailing Address - Phone:432-816-6871
Mailing Address - Fax:
Practice Address - Street 1:2009 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5909
Practice Address - Country:US
Practice Address - Phone:432-263-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility