Provider Demographics
NPI:1609236025
Name:MICHELLE'S CARE HOME
Entity Type:Organization
Organization Name:MICHELLE'S CARE HOME
Other - Org Name:JM MCCLELLAN PROPERTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-658-6986
Mailing Address - Street 1:1310 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-2239
Mailing Address - Country:US
Mailing Address - Phone:830-767-3082
Mailing Address - Fax:830-767-3082
Practice Address - Street 1:1310 POPLAR ST
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-2239
Practice Address - Country:US
Practice Address - Phone:830-767-3082
Practice Address - Fax:830-767-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144279310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612708747Medicaid