MEDICARE: SHORT GRASS INVESTMENT HOLDINGS LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1649858960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORT GRASS INVESTMENT HOLDINGS LLC

Provider Business Mailing Address
First Line	:	3029 INDEPENDENCE DRIVE
Second Line	:	SUITE 105
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4474
Country	:	US
Telephone Number	:	830-214-2059
Fax Number	:	830-214-8913

Provider Business Practice Location Address
First Line	:	3029 INDEPENDENCE DRIVE
Second Line	:	SUITE 105
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4474
Country	:	US
Telephone Number	:	830-214-2059
Fax Number	:	830-214-8913

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MR. JEFFREY MICHAEL CLARK
Credential	:
Telephone Number	:	830-214-2059

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	05/08/2025

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