Provider Demographics
NPI:1740539907
Name:BEYONDFAITH HOMECARE & REHAB OF JACKSBORO, LLC
Entity type:Organization
Organization Name:BEYONDFAITH HOMECARE & REHAB OF JACKSBORO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-521-0300
Mailing Address - Street 1:604 OAK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3070
Mailing Address - Country:US
Mailing Address - Phone:940-521-0300
Mailing Address - Fax:940-521-0323
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-2318
Practice Address - Country:US
Practice Address - Phone:940-521-0300
Practice Address - Fax:940-521-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
TX015206251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based