Provider Demographics
NPI:1609698315
Name:J & K ASSISTED LIVING II
Entity type:Organization
Organization Name:J & K ASSISTED LIVING II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KETLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:321-704-0053
Mailing Address - Street 1:256 BARBAROSSA RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1809
Mailing Address - Country:US
Mailing Address - Phone:321-704-0053
Mailing Address - Fax:321-345-4297
Practice Address - Street 1:256 BARBAROSSA RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1809
Practice Address - Country:US
Practice Address - Phone:321-704-0053
Practice Address - Fax:321-345-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility