Provider Demographics
NPI:1639724347
Name:SJ HEALTHCARE AGENCY LLC
Entity Type:Organization
Organization Name:SJ HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAZMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-355-2233
Mailing Address - Street 1:1212 GARZA ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3634
Mailing Address - Country:US
Mailing Address - Phone:956-520-8186
Mailing Address - Fax:
Practice Address - Street 1:1212 GARZA ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3634
Practice Address - Country:US
Practice Address - Phone:956-520-8186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based