Provider Demographics
NPI:1114011699
Name:JEFFERSON COUNTY HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-835-9909
Mailing Address - Street 1:2670 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702
Mailing Address - Country:US
Mailing Address - Phone:409-835-9909
Mailing Address - Fax:409-835-9949
Practice Address - Street 1:2670 LAUREL ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-835-9909
Practice Address - Fax:409-835-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002583251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677686Medicare Oscar/Certification