Provider Demographics
NPI:1619550126
Name:J&K COMFORT HOME
Entity Type:Organization
Organization Name:J&K COMFORT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYABICHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-735-5559
Mailing Address - Street 1:211 PALOMINO RD SE
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7317
Mailing Address - Country:US
Mailing Address - Phone:612-735-5559
Mailing Address - Fax:763-452-0206
Practice Address - Street 1:316 PALOMINO RD SE
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7332
Practice Address - Country:US
Practice Address - Phone:612-735-5559
Practice Address - Fax:763-452-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health