Provider Demographics
NPI:1285979591
Name:J & J HOME & COMMUNITY SUPPORT CORP
Entity type:Organization
Organization Name:J & J HOME & COMMUNITY SUPPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-409-2722
Mailing Address - Street 1:2450 SW 137 AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6332
Mailing Address - Country:US
Mailing Address - Phone:786-409-2722
Mailing Address - Fax:786-618-9184
Practice Address - Street 1:2450 SW 137 AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6332
Practice Address - Country:US
Practice Address - Phone:786-409-2722
Practice Address - Fax:786-618-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691481179Medicaid