Provider Demographics
NPI:1902817281
Name:J,K &L, INC.
Entity Type:Organization
Organization Name:J,K &L, INC.
Other - Org Name:SAN JUAN REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-293-7222
Mailing Address - Street 1:911 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2513
Mailing Address - Country:US
Mailing Address - Phone:360-293-7222
Mailing Address - Fax:360-293-7281
Practice Address - Street 1:911 21ST ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2513
Practice Address - Country:US
Practice Address - Phone:360-293-7222
Practice Address - Fax:360-293-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4113130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113130Medicaid
WA4113130Medicaid