Provider Demographics
NPI:1376579771
Name:JALSTAD VENTURES INCORPORATED
Entity Type:Organization
Organization Name:JALSTAD VENTURES INCORPORATED
Other - Org Name:JALSTAD HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAIWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-2967
Mailing Address - Street 1:3880 GREENHOUSE RD STE 417
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3487
Mailing Address - Country:US
Mailing Address - Phone:713-271-2967
Mailing Address - Fax:713-271-3031
Practice Address - Street 1:3880 GREENHOUSE RD STE 417
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3487
Practice Address - Country:US
Practice Address - Phone:713-271-2967
Practice Address - Fax:713-271-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017383251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677826Medicare ID - Type Unspecified