JDC Provider, Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

JDC PROVIDER, INC

Practice address

31520 Railroad Canyon Rd Ste a
Canyon Lake, CA 92587-9499

Phone

(951) 246-2550

Fax

(951) 246-2568

NPI assigned

Sep 17, 2019

Organization subpart

Yes

Parent organization

JDC PROVIDER, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Dain

Title

President

Phone

(951) 246-2550

Specialties & licenses 1

Addresses

Other names 1

• Caregiver Provider Doing business as

Part of

JDC Provider Inc

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1346890746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31520 RAILROAD CANYON RD STE A",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879499",
            "telephone_number": "951-246-2550",
            "fax_number": "951-246-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31520 RAILROAD CANYON RD STE A",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879499",
            "telephone_number": "951-246-2550",
            "fax_number": "951-246-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDC PROVIDER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JDC PROVIDER, INC",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "DAIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-246-2550"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caregiver Provider",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• In Home Supportive Care Agency in Canyon Lake, CA
• Providers in Canyon Lake, CA by specialty
• In Home Supportive Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.