Provider Demographics
NPI:1942450879
Name:JPAM MANAGEMENT & CONSULTING INC
Entity Type:Organization
Organization Name:JPAM MANAGEMENT & CONSULTING INC
Other - Org Name:AVALON GARDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENCICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-374-7419
Mailing Address - Street 1:12844 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5104
Mailing Address - Country:US
Mailing Address - Phone:314-374-7419
Mailing Address - Fax:
Practice Address - Street 1:4359 TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-1533
Practice Address - Country:US
Practice Address - Phone:314-752-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104650205Medicaid
MO104650205Medicaid