Provider Demographics
NPI:1376636365
Name:DANIEL JARVIS HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:DANIEL JARVIS HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:979-260-6941
Mailing Address - Street 1:4021 E 29TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4227
Mailing Address - Country:US
Mailing Address - Phone:979-260-6941
Mailing Address - Fax:979-260-6969
Practice Address - Street 1:4021 E 29TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4227
Practice Address - Country:US
Practice Address - Phone:979-260-6941
Practice Address - Fax:979-260-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457099Medicare ID - Type UnspecifiedCURRENT ID NUMBER