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Jack Lee Nicholson I
Attendant Care Provider in Lathrop, California
NPI 1831748318

Jack Lee Nicholson I is an Attendant Care Provider based in Lathrop, CA and is specialized in Attendant Care Provider. Jack Lee Nicholson I practices in Lathrop, CA. The NPI Number for Jack Lee Nicholson I is 1831748318 and holds a License No. (California).

The current practice location address for Jack Lee Nicholson I is 460 Aztec Ln, Lathrop, CA and can be reached out via phone at 209-451-8732.

Location: 460 Aztec Ln, Lathrop, CA, 95330-9142
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1831748318
Provider Name
Jack Lee Nicholson I
Credential
Provider Entity Type
Individual
Gender
Male
Address
460 Aztec Ln, Lathrop, CA, 95330-9142
Phone Number
209-451-8732
Fax Number
Provider Enumeration Date
09/08/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1933200000X 05 CA
3747A0650X 05 CA
193200000X 05 CA
institution
Provider Business Practice Location Address Details
Address
460 Aztec Ln
City
Lathrop
State
California
Zip
95330-9142
Phone Number
209-451-8732
Fax Number
person
Provider Business Mailing Address Details
Address
460 Aztec Ln
City
Lathrop
State
California
Zip
95330-9142
Phone Number
209-451-8732
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing Service Related Providers
Classification
Technician
Speciality
Attendant Care Provider
Taxonomy
3747A0650X
License No.
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Definition
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law.
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