Provider Demographics
NPI:1477620615
Name:JAKPA HEALTHCARE INC
Entity Type:Organization
Organization Name:JAKPA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OFIORITSE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBONTAEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-222-3100
Mailing Address - Street 1:285 W SOUTHWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7770
Mailing Address - Country:US
Mailing Address - Phone:214-222-3100
Mailing Address - Fax:214-222-3103
Practice Address - Street 1:401 MISTY LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6253
Practice Address - Country:US
Practice Address - Phone:214-222-3100
Practice Address - Fax:214-222-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X, 3747P1801X
TX008874251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013165OtherMDCP
TX001013167Medicaid
TX001013166Medicaid