Provider Demographics
NPI:1316608292
Name:JUGHEAD ENTERPRISES
Entity type:Organization
Organization Name:JUGHEAD ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DEMETRIC
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:717-672-6635
Mailing Address - Street 1:590 CENTERVILLE RD STE 363
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1306
Mailing Address - Country:US
Mailing Address - Phone:717-672-6635
Mailing Address - Fax:
Practice Address - Street 1:232 W MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1752
Practice Address - Country:US
Practice Address - Phone:717-672-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty