Provider Demographics
NPI:1508127325
Name:MDTJ CAREGIVERS,LLC
Entity Type:Organization
Organization Name:MDTJ CAREGIVERS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IBIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-628-7947
Mailing Address - Street 1:11707 EVESBOROUGH DR,
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099
Mailing Address - Country:US
Mailing Address - Phone:281-498-7340
Mailing Address - Fax:281-809-5982
Practice Address - Street 1:11707 EVESBOROUGH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1907
Practice Address - Country:US
Practice Address - Phone:281-498-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric