Provider Demographics
NPI:1285943456
Name:JCL IN-HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:JCL IN-HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-921-9448
Mailing Address - Street 1:563 HOWDERSHELL RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6401
Mailing Address - Country:US
Mailing Address - Phone:314-921-9448
Mailing Address - Fax:314-921-9440
Practice Address - Street 1:563 HOWDERSHELL RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6401
Practice Address - Country:US
Practice Address - Phone:314-921-9448
Practice Address - Fax:314-921-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007914251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health