Provider Demographics
NPI:1124717764
Name:JLK STRENGTH LLC
Entity type:Organization
Organization Name:JLK STRENGTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLASBEETS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-933-1931
Mailing Address - Street 1:27181 ASHTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17280 NEWHOPE ST STE 18
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4282
Practice Address - Country:US
Practice Address - Phone:949-531-1624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder