MEDICARE: JMJSENIORCITIZENGROUPHOME

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	310400000X	Assisted Living Facility	102612	TX

General Provider Information

NPI Number	:	1437608072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMJSENIORCITIZENGROUPHOME

Provider Business Mailing Address
First Line	:	4301 KEY WEST DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-5015
Country	:	US
Telephone Number	:	361-334-7460
Fax Number	:	361-334-5598

Provider Business Practice Location Address
First Line	:	4301 KEY WEST DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-5015
Country	:	US
Telephone Number	:	361-334-7460
Fax Number	:	361-334-5598

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOEL GARCIA
Credential	:	R.N.
Telephone Number	:	361-334-7460

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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