Provider Demographics
NPI:1770103954
Name:JCL HEALTHCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:JCL HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LIEF
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:BALBOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-291-2861
Mailing Address - Street 1:10161 W LAWRENCE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7380
Mailing Address - Country:US
Mailing Address - Phone:623-440-7802
Mailing Address - Fax:
Practice Address - Street 1:10161 W LAWRENCE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7380
Practice Address - Country:US
Practice Address - Phone:623-440-7802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility