Provider Demographics
NPI:1275994550
Name:HIDDEN JEWEL HEALTHCARE RESOURE SERVICE
Entity Type:Organization
Organization Name:HIDDEN JEWEL HEALTHCARE RESOURE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-789-9205
Mailing Address - Street 1:PO BOX 398370
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75339-8370
Mailing Address - Country:US
Mailing Address - Phone:469-789-9205
Mailing Address - Fax:972-224-0411
Practice Address - Street 1:1305 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-1688
Practice Address - Country:US
Practice Address - Phone:469-789-9205
Practice Address - Fax:972-224-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid