Provider Demographics
NPI:1376797365
Name:J & L ADULT CARE
Entity Type:Organization
Organization Name:J & L ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA.
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLUBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-390-4462
Mailing Address - Street 1:5034 BAILEY RD NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3706
Mailing Address - Country:US
Mailing Address - Phone:503-390-4462
Mailing Address - Fax:
Practice Address - Street 1:5034 BAILEY RD NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3706
Practice Address - Country:US
Practice Address - Phone:503-390-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health