Provider Demographics
NPI:1649853813
Name:JERIAH HOME CARE SERVICE
Entity type:Organization
Organization Name:JERIAH HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-621-1111
Mailing Address - Street 1:451 E ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3393
Mailing Address - Country:US
Mailing Address - Phone:956-621-1111
Mailing Address - Fax:956-621-1130
Practice Address - Street 1:451 E ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3393
Practice Address - Country:US
Practice Address - Phone:956-621-1111
Practice Address - Fax:956-621-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty