Provider Demographics
NPI:1790238764
Name:SRC HOME CARE JC INC
Entity Type:Organization
Organization Name:SRC HOME CARE JC INC
Other - Org Name:RIGHT AT HOME- JOSHUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARLOTTA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-313-3169
Mailing Address - Street 1:3012 RUNNING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-5756
Mailing Address - Country:US
Mailing Address - Phone:817-313-3169
Mailing Address - Fax:
Practice Address - Street 1:474 NORTH BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058
Practice Address - Country:US
Practice Address - Phone:817-313-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health