Provider Demographics
NPI:1467220343
Name:T&JK FAMILY HOME SUPPORT SERVICES
Entity Type:Organization
Organization Name:T&JK FAMILY HOME SUPPORT SERVICES
Other - Org Name:T&JK FAMILY HOME SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-717-3535
Mailing Address - Street 1:PO BOX 2398
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-7198
Mailing Address - Country:US
Mailing Address - Phone:313-717-3535
Mailing Address - Fax:
Practice Address - Street 1:19499 WESTBROOK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1921
Practice Address - Country:US
Practice Address - Phone:313-717-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty