Provider Demographics
NPI:1114087467
Name:KELLI JONES
Entity Type:Organization
Organization Name:KELLI JONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR,OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-496-9255
Mailing Address - Street 1:887 NOB HL
Mailing Address - Street 2:
Mailing Address - City:WOLFE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75496-3007
Mailing Address - Country:US
Mailing Address - Phone:903-496-9255
Mailing Address - Fax:
Practice Address - Street 1:887 NOB HL
Practice Address - Street 2:
Practice Address - City:WOLFE CITY
Practice Address - State:TX
Practice Address - Zip Code:75496-3007
Practice Address - Country:US
Practice Address - Phone:903-496-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness