Provider Demographics
NPI:1033890769
Name:JACK AND GEORGE HOME CARE LLC
Entity Type:Organization
Organization Name:JACK AND GEORGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-417-8427
Mailing Address - Street 1:4896 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3682
Mailing Address - Country:US
Mailing Address - Phone:847-417-8427
Mailing Address - Fax:423-269-2613
Practice Address - Street 1:4896 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3682
Practice Address - Country:US
Practice Address - Phone:847-417-8427
Practice Address - Fax:423-269-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care