Provider Demographics
NPI:1437783677
Name:JLAB INC
Entity Type:Organization
Organization Name:JLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-264-7933
Mailing Address - Street 1:10650 54TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2231
Mailing Address - Country:US
Mailing Address - Phone:951-685-9000
Mailing Address - Fax:951-685-9000
Practice Address - Street 1:10650 54TH STREET
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-2231
Practice Address - Country:US
Practice Address - Phone:951-685-9000
Practice Address - Fax:951-685-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility