Provider Demographics
NPI:1114920923
Name:JAMES JEWEL
Entity Type:Organization
Organization Name:JAMES JEWEL
Other - Org Name:AMBERWOOD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COURT APPOINTED TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:CROWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-385-0863
Mailing Address - Street 1:215 W BANDERA RD
Mailing Address - Street 2:SUITE 114 PMB 616
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2820
Mailing Address - Country:US
Mailing Address - Phone:713-385-0863
Mailing Address - Fax:
Practice Address - Street 1:601 S OHIO CIRCLE
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-6416
Practice Address - Country:US
Practice Address - Phone:713-385-0863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112770314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
676054Medicare Oscar/Certification