Provider Demographics
NPI:1245091560
Name:J & J HOME & COMMUNITY SUPPORT CORP
Entity type:Organization
Organization Name:J & J HOME & COMMUNITY SUPPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-2722
Mailing Address - Street 1:2450 SW 137 AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6332
Mailing Address - Country:US
Mailing Address - Phone:786-409-2722
Mailing Address - Fax:786-618-9184
Practice Address - Street 1:9141 OVERSEAS HWY
Practice Address - Street 2:UNIT 2
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3247
Practice Address - Country:US
Practice Address - Phone:786-409-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007205200Medicaid