Provider Demographics
NPI:1366313231
Name:JAATIMA ADULT FOSTER HOME LLC
Entity type:Organization
Organization Name:JAATIMA ADULT FOSTER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MARIAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-594-3949
Mailing Address - Street 1:2454 LYON ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-4803
Mailing Address - Country:US
Mailing Address - Phone:978-594-3949
Mailing Address - Fax:541-791-7670
Practice Address - Street 1:2454 LYON ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4803
Practice Address - Country:US
Practice Address - Phone:978-594-3949
Practice Address - Fax:541-791-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty