Provider Demographics
NPI:1699545186
Name:J4 HOME CARE LLC
Entity type:Organization
Organization Name:J4 HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-943-1952
Mailing Address - Street 1:1515 N WARSON RD STE 287
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1165
Mailing Address - Country:US
Mailing Address - Phone:314-943-1952
Mailing Address - Fax:
Practice Address - Street 1:1515 N WARSON RD STE 287
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1165
Practice Address - Country:US
Practice Address - Phone:314-943-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty