Provider Demographics
NPI:1902312101
Name:JT PRIVATE DUTY HOME CARE, LLC
Entity Type:Organization
Organization Name:JT PRIVATE DUTY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-878-4510
Mailing Address - Street 1:27499 RIVERVIEW CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27499 RIVERVIEW CENTER BLVD STE 207
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4334
Practice Address - Country:US
Practice Address - Phone:239-896-6582
Practice Address - Fax:239-645-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherINSURANCE COMPANY