Provider Demographics
NPI:1679817530
Name:K & J ENTERPRISE
Entity Type:Organization
Organization Name:K & J ENTERPRISE
Other - Org Name:K & J MEDICAL SUPPLIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-469-4768
Mailing Address - Street 1:3501 FOXCLIFF CT
Mailing Address - Street 2:203
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4927
Mailing Address - Country:US
Mailing Address - Phone:410-419-0238
Mailing Address - Fax:
Practice Address - Street 1:3501 FOXCLIFF CT
Practice Address - Street 2:203
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4927
Practice Address - Country:US
Practice Address - Phone:410-419-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility