Provider Demographics
NPI:1356641005
Name:JERICHO HOUSE LLC
Entity Type:Organization
Organization Name:JERICHO HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LASHONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-288-0328
Mailing Address - Street 1:17424 W GRAND PKWY
Mailing Address - Street 2:SUITE 282
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2564
Mailing Address - Country:US
Mailing Address - Phone:832-288-0328
Mailing Address - Fax:281-605-5610
Practice Address - Street 1:4845 RUE STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033
Practice Address - Country:US
Practice Address - Phone:832-288-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility