MEDICARE: J-SHALOM HOME HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	3747A0650X	Attendant Care Provider
3	3747P1801X	Personal Care Attendant
4	385H00000X	Respite Care
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1669615068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J-SHALOM HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	1416 JUNCTION RUN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4409
Country	:	US
Telephone Number	:	469-592-2669
Fax Number	:	972-591-4589

Provider Business Practice Location Address
First Line	:	1416 JUNCTION RUN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4409
Country	:	US
Telephone Number	:	469-592-2669
Fax Number	:	972-591-4589

Authorized Official
Title or Position	:	OWNER
Name	:	MR. OKUNBOR ALFRED-IYAMU
Credential	:
Telephone Number	:	469-592-2669

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	08/07/2023

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