Provider Demographics
NPI:1609609635
Name:JNK MANAGEMENT LLC.
Entity type:Organization
Organization Name:JNK MANAGEMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKSON
Authorized Official - Middle Name:N
Authorized Official - Last Name:KASUE
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:801-694-7071
Mailing Address - Street 1:10718 S 2420 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8659
Mailing Address - Country:US
Mailing Address - Phone:801-694-7071
Mailing Address - Fax:
Practice Address - Street 1:10718 S 2420 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8659
Practice Address - Country:US
Practice Address - Phone:801-694-7071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDHHSOtherDSPD
UT8016947071OtherDHHS
UT152937369OtherDRIVER LICENSE #
UT152937369Medicaid