Provider Demographics
NPI:1912208133
Name:J & J RESIDENTIAL SERVICES INCORPORATED
Entity Type:Organization
Organization Name:J & J RESIDENTIAL SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:740-733-7095
Mailing Address - Street 1:65 TANNER STREET
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43948
Mailing Address - Country:US
Mailing Address - Phone:740-733-7095
Mailing Address - Fax:740-733-8509
Practice Address - Street 1:43 GREENE STREET
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:OH
Practice Address - Zip Code:43948
Practice Address - Country:US
Practice Address - Phone:740-733-7095
Practice Address - Fax:740-733-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4110054385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4100574OtherMEDICAID