1710178090 NPI number — JAIMEL HEALTH CARE SERVICE LLC

Table of content: (NPI 1710178090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710178090 NPI number — JAIMEL HEALTH CARE SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAIMEL HEALTH CARE SERVICE LLC
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:
Provider Other Organization Name Type Code:
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:
1710178090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9950 WESTPARK DR
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77063-5138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-780-2968
Provider Business Mailing Address Fax Number:
713-780-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9950 WESTPARK DR
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77063-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-780-2968
Provider Business Practice Location Address Fax Number:
713-780-2936
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TORAN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-780-2968

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  012039 , 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)

  • Identifier: 001016373 . This is a "TX DADS - MDCP PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001020338 . This is a "TX DADS - 24 HR SHARED ATTENDANT CARE PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001016121 . This is a "TX DADS - CLASS PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001016372 . This is a "TX DADS - PHC PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 201976201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74-3198 . This is a "MEDICARE CERTIFICATION # (CCN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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