Provider Demographics
NPI:1336669803
Name:K & J 1602 MANAGMENT INCORPORATE
Entity Type:Organization
Organization Name:K & J 1602 MANAGMENT INCORPORATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-217-6817
Mailing Address - Street 1:1602 REGENE ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5316
Mailing Address - Country:US
Mailing Address - Phone:909-217-6817
Mailing Address - Fax:
Practice Address - Street 1:1602 REGENE ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5316
Practice Address - Country:US
Practice Address - Phone:909-217-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities