Provider Demographics
NPI:1568813657
Name:JD FISHER LLC
Entity Type:Organization
Organization Name:JD FISHER LLC
Other - Org Name:COMFORT KEEPERS#308
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LISCENSEE
Authorized Official - Phone:909-499-2731
Mailing Address - Street 1:31629 OUTER HIGHWAY 10 STE F
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7590
Mailing Address - Country:US
Mailing Address - Phone:909-798-1199
Mailing Address - Fax:909-797-4421
Practice Address - Street 1:31629 OUTER HIGHWAY 10 STE F
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7590
Practice Address - Country:US
Practice Address - Phone:909-798-1199
Practice Address - Fax:909-797-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364700006253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care