Provider Demographics
NPI:1679864987
Name:JESSE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:JESSE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-553-9320
Mailing Address - Street 1:1715 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-5531
Mailing Address - Country:US
Mailing Address - Phone:972-495-0172
Mailing Address - Fax:972-495-0367
Practice Address - Street 1:1715 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-5531
Practice Address - Country:US
Practice Address - Phone:972-495-0172
Practice Address - Fax:972-495-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health