Provider Demographics
NPI:1780633123
Name:JASSAN INC
Entity type:Organization
Organization Name:JASSAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BS,MBA
Authorized Official - Phone:713-791-1841
Mailing Address - Street 1:3615 WILLOWBEND BLVD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1115
Mailing Address - Country:US
Mailing Address - Phone:713-660-9600
Mailing Address - Fax:713-791-9352
Practice Address - Street 1:3615 WILLOWBEND BLVD
Practice Address - Street 2:SUITE 424
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1115
Practice Address - Country:US
Practice Address - Phone:713-660-9600
Practice Address - Fax:713-791-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508645OtherBLUE CROSS BLUE SHIELD
TX015742201Medicaid
TX078960401Medicaid
TX086839001Medicaid
TX015742201Medicaid