Provider Demographics
NPI:1922445105
Name:J JIREH LLC
Entity Type:Organization
Organization Name:J JIREH LLC
Other - Org Name:WINDSOR PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-746-5369
Mailing Address - Street 1:507 E W M WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAINGERFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75638-2013
Mailing Address - Country:US
Mailing Address - Phone:903-645-3915
Mailing Address - Fax:903-645-2288
Practice Address - Street 1:507 E W M WATSON BLVD
Practice Address - Street 2:
Practice Address - City:DAINGERFIELD
Practice Address - State:TX
Practice Address - Zip Code:75638-2013
Practice Address - Country:US
Practice Address - Phone:903-645-3915
Practice Address - Fax:903-645-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004568Medicaid
TX004568Medicaid