Provider Demographics
NPI:1104535913
Name:JJ GROUP
Entity type:Organization
Organization Name:JJ GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADWANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-572-9009
Mailing Address - Street 1:2517 TURQUOISE CIR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2158
Mailing Address - Country:US
Mailing Address - Phone:213-572-9909
Mailing Address - Fax:
Practice Address - Street 1:23232 PERALTA DR STE 216
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1438
Practice Address - Country:US
Practice Address - Phone:213-572-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care