Provider Demographics
NPI:1649811316
Name:JACEELLI HEALTHCARE
Entity type:Organization
Organization Name:JACEELLI HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ABAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-215-0223
Mailing Address - Street 1:213 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5611
Mailing Address - Country:US
Mailing Address - Phone:832-215-0223
Mailing Address - Fax:
Practice Address - Street 1:213 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5611
Practice Address - Country:US
Practice Address - Phone:832-215-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty