Provider Demographics
NPI:1295714673
Name:J LOAM INC
Entity type:Organization
Organization Name:J LOAM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TCRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-946-6666
Mailing Address - Street 1:2721 E. RUSSELL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2490
Mailing Address - Country:US
Mailing Address - Phone:702-946-6666
Mailing Address - Fax:702-946-6670
Practice Address - Street 1:2721 E. RUSSEL ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2490
Practice Address - Country:US
Practice Address - Phone:702-946-6666
Practice Address - Fax:702-946-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3688HHA3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500696Medicaid
297104Medicare UPIN