Provider Demographics
NPI:1225583339
Name:SJ HOME CARE
Entity Type:Organization
Organization Name:SJ HOME CARE
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISSET
Authorized Official - Suffix:
Authorized Official - Credentials:HCC, MC
Authorized Official - Phone:903-215-8183
Mailing Address - Street 1:401 E FRONT ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8213
Mailing Address - Country:US
Mailing Address - Phone:903-581-5122
Mailing Address - Fax:903-215-8184
Practice Address - Street 1:1605 JUDSON RD
Practice Address - Street 2:SUITE B-F
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3662
Practice Address - Country:US
Practice Address - Phone:903-215-8183
Practice Address - Fax:903-215-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0147393747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty