Provider Demographics
NPI:1649505512
Name:J & K IN-HOME CARE, INC.
Entity type:Organization
Organization Name:J & K IN-HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRIKKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MLPN/GT
Authorized Official - Phone:937-223-1635
Mailing Address - Street 1:12 NAAS PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2054
Mailing Address - Country:US
Mailing Address - Phone:937-223-1635
Mailing Address - Fax:937-223-1503
Practice Address - Street 1:12 NAAS PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2054
Practice Address - Country:US
Practice Address - Phone:937-223-1635
Practice Address - Fax:937-223-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104976Medicaid