Provider Demographics
NPI:1427694595
Name:JANET'S ENTERPRISE, INC
Entity type:Organization
Organization Name:JANET'S ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-545-4462
Mailing Address - Street 1:904 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4576
Mailing Address - Country:US
Mailing Address - Phone:951-545-4462
Mailing Address - Fax:909-577-0111
Practice Address - Street 1:904 W 9TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4576
Practice Address - Country:US
Practice Address - Phone:951-545-4462
Practice Address - Fax:909-577-0111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANET'S ENTERPRISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240000125Medicaid