Provider Demographics
NPI:1437608072
Name:JMJSENIORCITIZENGROUPHOME
Entity Type:Organization
Organization Name:JMJSENIORCITIZENGROUPHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-334-7460
Mailing Address - Street 1:4301 KEY WEST DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5015
Mailing Address - Country:US
Mailing Address - Phone:361-334-7460
Mailing Address - Fax:361-334-5598
Practice Address - Street 1:4301 KEY WEST DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5015
Practice Address - Country:US
Practice Address - Phone:361-334-7460
Practice Address - Fax:361-334-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102612310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility