Provider Demographics
NPI:1912264508
Name:J & K ASSISTED LIVING,INC
Entity Type:Organization
Organization Name:J & K ASSISTED LIVING,INC
Other - Org Name:J & K ASSISTED LIVING II
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KETLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-327-3501
Mailing Address - Street 1:155 AVIATION AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3022
Mailing Address - Country:US
Mailing Address - Phone:321-327-3501
Mailing Address - Fax:
Practice Address - Street 1:155 AVIATION AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3022
Practice Address - Country:US
Practice Address - Phone:321-327-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11762310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility