Provider Demographics
NPI:1114972288
Name:P J R GROUP INC
Entity Type:Organization
Organization Name:P J R GROUP INC
Other - Org Name:INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:210-377-2559
Mailing Address - Street 1:5368 FREDRICKSBURG RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-377-2559
Mailing Address - Fax:210-525-1842
Practice Address - Street 1:5368 FREDRICKSBURG RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-377-2559
Practice Address - Fax:210-525-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008912Medicaid
677504Medicare ID - Type Unspecified