MEDICARE: SJ HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	014739	TX

General Provider Information

NPI Number	:	1225583339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJ HOME CARE

Provider Business Mailing Address
First Line	:	401 E FRONT ST
Second Line	:	SUITE 245
City	:	TYLER
State	:	TX
Zip	:	75702-8213
Country	:	US
Telephone Number	:	903-581-5122
Fax Number	:	903-215-8184

Provider Business Practice Location Address
First Line	:	1605 JUDSON RD
Second Line	:	SUITE B-F
City	:	LONGVIEW
State	:	TX
Zip	:	75601-3662
Country	:	US
Telephone Number	:	903-215-8183
Fax Number	:	903-215-8184

Authorized Official
Title or Position	:	ALTERNATE ADMINISTRATOR
Name	:	MS. JACKIE BRISSET
Credential	:	HCC, MC
Telephone Number	:	903-215-8183

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	08/18/2016

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Directions to “SJ HOME CARE ” Practice Location

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