Provider Demographics
NPI:1346989993
Name:JENKINSON CO LLC
Entity type:Organization
Organization Name:JENKINSON CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-748-8328
Mailing Address - Street 1:500 S WINMERE AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:IN
Mailing Address - Zip Code:47383-9427
Mailing Address - Country:US
Mailing Address - Phone:765-748-8328
Mailing Address - Fax:
Practice Address - Street 1:500 S WINMERE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:IN
Practice Address - Zip Code:47383-9427
Practice Address - Country:US
Practice Address - Phone:765-748-8328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty