1710158332 NPI number — J & J HOME HEALTH AGENCY INC.

Table of content: (NPI 1710158332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710158332 NPI number — J & J HOME HEALTH AGENCY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J & J HOME HEALTH AGENCY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
J.P.M. DIVERSIFIED ENTERPRISES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710158332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2716 COUNTY ROAD 804A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-800-5630
Provider Business Mailing Address Fax Number:
817-447-9958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E LOS EBANOS BLVD
Provider Second Line Business Practice Location Address:
BLDG 'A'
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-8634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-546-7100
Provider Business Practice Location Address Fax Number:
956-546-7108
Provider Enumeration Date:
03/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOSES
Authorized Official First Name:
JASON
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-800-5630

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0093369 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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