Provider Demographics
NPI:1902654312
Name:JUPON FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:JUPON FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S W
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:202-702-7532
Mailing Address - Street 1:4083 34TH AVE S APT 201
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5261
Mailing Address - Country:US
Mailing Address - Phone:202-702-7532
Mailing Address - Fax:
Practice Address - Street 1:4083 34TH AVE S APT 201
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5261
Practice Address - Country:US
Practice Address - Phone:202-702-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care