Provider Demographics
NPI:1437915584
Name:JKC LIFE LLC
Entity Type:Organization
Organization Name:JKC LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCIO CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-610-6777
Mailing Address - Street 1:228 S MALL PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2210
Mailing Address - Country:US
Mailing Address - Phone:657-610-6777
Mailing Address - Fax:
Practice Address - Street 1:228 S MALL PL
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2210
Practice Address - Country:US
Practice Address - Phone:657-610-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)