Provider Demographics
NPI:1881987865
Name:JKG HOME HEALTH CARE
Entity type:Organization
Organization Name:JKG HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENEEN
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:GAVANA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:570-926-5698
Mailing Address - Street 1:324 SOPHIA COXE DR
Mailing Address - Street 2:
Mailing Address - City:DRIFTON
Mailing Address - State:PA
Mailing Address - Zip Code:18221-0283
Mailing Address - Country:US
Mailing Address - Phone:570-926-5698
Mailing Address - Fax:
Practice Address - Street 1:324 SOPHIA COXE DR
Practice Address - Street 2:
Practice Address - City:DRIFTON
Practice Address - State:PA
Practice Address - Zip Code:18221
Practice Address - Country:US
Practice Address - Phone:570-926-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9956348253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care