Provider Demographics
NPI:1437553740
Name:4J'S
Entity Type:Organization
Organization Name:4J'S
Other - Org Name:ANGEL'S TOUCH II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSORCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-482-0672
Mailing Address - Street 1:1735 JEFFORDS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4560
Mailing Address - Country:US
Mailing Address - Phone:727-447-8558
Mailing Address - Fax:727-253-4559
Practice Address - Street 1:1735 JEFFORDS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4560
Practice Address - Country:US
Practice Address - Phone:727-447-8558
Practice Address - Fax:727-253-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 5034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility