Provider Demographics
NPI:1689328429
Name:J&S FAMILY HOME CARE LLC
Entity Type:Organization
Organization Name:J&S FAMILY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERICKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-374-8446
Mailing Address - Street 1:3219 FLOWE ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6711
Mailing Address - Country:US
Mailing Address - Phone:443-374-8446
Mailing Address - Fax:
Practice Address - Street 1:3219 FLOWE ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6711
Practice Address - Country:US
Practice Address - Phone:443-374-8446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care