Provider Demographics
NPI:1376956169
Name:JL REGISTERED NURSING HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JL REGISTERED NURSING HOME HEALTHCARE, INC.
Other - Org Name:INTERIM HEALTHCARE PERSONAL CARE AND SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIEU
Authorized Official - Middle Name:THI
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-691-6974
Mailing Address - Street 1:11992 STATE HIGHWAY 88
Mailing Address - Street 2:SUITE 2046
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9404
Mailing Address - Country:US
Mailing Address - Phone:209-223-9112
Mailing Address - Fax:
Practice Address - Street 1:11992 STATE HIGHWAY 88
Practice Address - Street 2:SUITE 2046
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9404
Practice Address - Country:US
Practice Address - Phone:209-223-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care