Provider Demographics
NPI:1609270594
Name:JAE'S HOUSE OF HOPE LLC
Entity Type:Organization
Organization Name:JAE'S HOUSE OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATWANYA
Authorized Official - Middle Name:JANEA
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP-BC
Authorized Official - Phone:214-384-6466
Mailing Address - Street 1:2131 N COLLINS ST
Mailing Address - Street 2:SUITE 433-320
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2849
Mailing Address - Country:US
Mailing Address - Phone:682-808-4510
Mailing Address - Fax:682-808-4511
Practice Address - Street 1:2131 N COLLINS ST
Practice Address - Street 2:SUITE 433-320
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2849
Practice Address - Country:US
Practice Address - Phone:682-808-4510
Practice Address - Fax:682-808-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility