Provider Demographics
NPI:1801134648
Name:JUST ONE NURSE
Entity type:Organization
Organization Name:JUST ONE NURSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR-DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:267-246-3222
Mailing Address - Street 1:5425 WYNNEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1323
Mailing Address - Country:US
Mailing Address - Phone:888-791-9145
Mailing Address - Fax:
Practice Address - Street 1:5425 WYNNEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1323
Practice Address - Country:US
Practice Address - Phone:888-791-9145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4151228311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home