Provider Demographics
NPI:1760616122
Name:JCB ADULT DAY SERVICE
Entity Type:Organization
Organization Name:JCB ADULT DAY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATHERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-399-1407
Mailing Address - Street 1:21500 GREENFIELD RD
Mailing Address - Street 2:STE 201
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3009
Mailing Address - Country:US
Mailing Address - Phone:248-556-5819
Mailing Address - Fax:248-522-2344
Practice Address - Street 1:21500 GREENFIELD RD
Practice Address - Street 2:STE 201
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3009
Practice Address - Country:US
Practice Address - Phone:248-556-5819
Practice Address - Fax:248-522-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle