Provider Demographics
NPI:1801206313
Name:JMAXHQ LLC
Entity Type:Organization
Organization Name:JMAXHQ LLC
Other - Org Name:HEALTHQUEST WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:321-795-9345
Mailing Address - Street 1:5 INDIAN RIVER AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5811
Mailing Address - Country:US
Mailing Address - Phone:321-795-9345
Mailing Address - Fax:321-385-9142
Practice Address - Street 1:1526 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3268
Practice Address - Country:US
Practice Address - Phone:321-267-8141
Practice Address - Fax:321-385-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM32410305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization