Provider Demographics
NPI:1669051314
Name:JEANUINE, INC. DBA COMFORT KEEPERS 302
Entity type:Organization
Organization Name:JEANUINE, INC. DBA COMFORT KEEPERS 302
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-453-3727
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0039
Mailing Address - Country:US
Mailing Address - Phone:817-453-3727
Mailing Address - Fax:817-453-1140
Practice Address - Street 1:2364 HIGHWAY 287 N STE 115
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9206
Practice Address - Country:US
Practice Address - Phone:817-453-3727
Practice Address - Fax:817-453-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009489OtherPERSONAL CARE LICENSE # STATE OF TEXAS