Provider Demographics
NPI:1417037946
Name:JBJC INC.
Entity Type:Organization
Organization Name:JBJC INC.
Other - Org Name:PINE STREET PHYSICAL & OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-837-7176
Mailing Address - Street 1:PO BOX 200880
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0880
Mailing Address - Country:US
Mailing Address - Phone:678-837-7176
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:534 E PINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5536
Practice Address - Country:US
Practice Address - Phone:209-463-5800
Practice Address - Fax:209-463-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA2403966261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23015ZMedicare ID - Type Unspecified