Provider Demographics
NPI:1073575411
Name:J-RAPHA CLINIC, LLC
Entity Type:Organization
Organization Name:J-RAPHA CLINIC, LLC
Other - Org Name:J-RAPHA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-980-1211
Mailing Address - Street 1:10534 SPANISH GRANT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1428
Mailing Address - Country:US
Mailing Address - Phone:281-980-1211
Mailing Address - Fax:281-980-1288
Practice Address - Street 1:10534 SPANISH GRANT DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1428
Practice Address - Country:US
Practice Address - Phone:281-980-1211
Practice Address - Fax:281-980-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679056Medicare ID - Type UnspecifiedPROVIDER NUMBER