Provider Demographics
NPI:1922320449
Name:JESSLEE CORPORATION
Entity Type:Organization
Organization Name:JESSLEE CORPORATION
Other - Org Name:HOME TO YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-724-1741
Mailing Address - Street 1:243 INDEPENDENCE SPGS
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3335
Mailing Address - Country:US
Mailing Address - Phone:903-890-7093
Mailing Address - Fax:
Practice Address - Street 1:243 INDEPENDENCE SPGS
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3335
Practice Address - Country:US
Practice Address - Phone:903-890-7093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128191310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001018030Medicaid