Provider Demographics
NPI:1801037742
Name:JOLLY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:JOLLY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTICE
Authorized Official - Middle Name:JOLLY
Authorized Official - Last Name:AMAECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-213-3315
Mailing Address - Street 1:20322 MATHIS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6178
Mailing Address - Country:US
Mailing Address - Phone:281-213-3315
Mailing Address - Fax:281-213-3315
Practice Address - Street 1:20322 MATHIS LANDING DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6178
Practice Address - Country:US
Practice Address - Phone:281-213-3315
Practice Address - Fax:281-213-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207206801Medicaid
TX251E00000XOtherHOME HEALTH
TX251E00000XMedicaid