Provider Demographics
NPI:1447432596
Name:JERICHO HEALTH SERVICE, INC.
Entity Type:Organization
Organization Name:JERICHO HEALTH SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEHU
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:LEDEZMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-546-7500
Mailing Address - Street 1:255 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4934
Mailing Address - Country:US
Mailing Address - Phone:956-546-7500
Mailing Address - Fax:956-546-3245
Practice Address - Street 1:255 MORNINGSIDE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4934
Practice Address - Country:US
Practice Address - Phone:956-546-7500
Practice Address - Fax:956-546-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 3747P1801X
TX009279251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447432596Medicaid