# JDC PROVIDER, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JDC PROVIDER, INC
- **Other names:** Caregiver Provider
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346890746
- **Legal business name:** JDC PROVIDER, INC
- **Authorized official:** JENNIFER DAIN (PRESIDENT)
- **Authorized official phone:** (951) 246-2550

## Contact information

- **Practice address:** 31520 RAILROAD CANYON RD STE A, CANYON LAKE, CA 92587-9499
- **Practice address phone:** (951) 246-2550
- **Practice address fax:** (951) 246-2568
- **Mailing address:** 31520 RAILROAD CANYON RD STE A, CANYON LAKE, CA 92587-9499
- **Mailing address phone:** (951) 246-2550
- **Mailing address fax:** (951) 246-2568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 09/17/2019
- **Last updated:** 09/17/2019