Provider Demographics
NPI:1710158332
Name:J & J HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:J & J HOME HEALTH AGENCY INC.
Other - Org Name:J.P.M. DIVERSIFIED ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:817-800-5630
Mailing Address - Street 1:2716 COUNTY ROAD 804A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1950
Mailing Address - Country:US
Mailing Address - Phone:817-800-5630
Mailing Address - Fax:817-447-9958
Practice Address - Street 1:1301 E LOS EBANOS BLVD
Practice Address - Street 2:BLDG 'A'
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8634
Practice Address - Country:US
Practice Address - Phone:956-546-7100
Practice Address - Fax:956-546-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-23
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093369332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1323870001Medicare NSC