Provider Demographics
NPI:1760667182
Name:JSP LIFE AGENCY INC.
Entity Type:Organization
Organization Name:JSP LIFE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENTS SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-944-4705
Mailing Address - Street 1:279-281 E. 204TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-944-4705
Mailing Address - Fax:718-944-5257
Practice Address - Street 1:279 E. 204TH ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3225
Practice Address - Country:US
Practice Address - Phone:718-944-4705
Practice Address - Fax:718-944-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1169L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health