Provider Demographics
NPI:1013773118
Name:JBD HOME HEALTH AIDE LLC
Entity Type:Organization
Organization Name:JBD HOME HEALTH AIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DERENONCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-297-0191
Mailing Address - Street 1:15 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1769
Mailing Address - Country:US
Mailing Address - Phone:774-297-0191
Mailing Address - Fax:
Practice Address - Street 1:15 MIDLAND ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1769
Practice Address - Country:US
Practice Address - Phone:774-297-0191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty