Provider Demographics
NPI:1831730746
Name:JAI RESIDENTIAL CARE HOME 2
Entity type:Organization
Organization Name:JAI RESIDENTIAL CARE HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMONRUT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-212-9384
Mailing Address - Street 1:5858 POINT RIDER CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3474
Mailing Address - Country:US
Mailing Address - Phone:720-212-9384
Mailing Address - Fax:
Practice Address - Street 1:5858 POINT RIDER CIR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3474
Practice Address - Country:US
Practice Address - Phone:720-212-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility