Provider Demographics
NPI:1710685318
Name:JTM GROUP HOME LLC
Entity Type:Organization
Organization Name:JTM GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMENLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-747-1433
Mailing Address - Street 1:1435 AKARD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3121
Mailing Address - Country:US
Mailing Address - Phone:775-747-1433
Mailing Address - Fax:
Practice Address - Street 1:1435 AKARD DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3121
Practice Address - Country:US
Practice Address - Phone:775-747-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility