Provider Demographics
NPI:1033130034
Name:JESSNIC HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:JESSNIC HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMOILE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:214-727-2247
Mailing Address - Street 1:1140 EMPIRE CENTRAL DR STE 245
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4325
Mailing Address - Country:US
Mailing Address - Phone:214-272-7527
Mailing Address - Fax:214-272-7565
Practice Address - Street 1:1140 EMPIRE CENTRAL DR STE 245
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4325
Practice Address - Country:US
Practice Address - Phone:214-727-2247
Practice Address - Fax:214-727-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006779251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX678208Medicare Oscar/Certification