Provider Demographics
NPI:1073088720
Name:JMDK HEALTHCARE LLC
Entity type:Organization
Organization Name:JMDK HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-200-7177
Mailing Address - Street 1:7177 BROCKTON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2632
Mailing Address - Country:US
Mailing Address - Phone:800-200-7177
Mailing Address - Fax:909-219-9939
Practice Address - Street 1:7177 BROCKTON AVE STE 108
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2632
Practice Address - Country:US
Practice Address - Phone:800-200-7177
Practice Address - Fax:909-219-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based