MEDICARE: EJV HOME CARE SERVICES, 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	:	1669710661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJV HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	7824 VINEYARD CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-9244
Country	:	US
Telephone Number	:	817-918-3485
Fax Number	:

Provider Business Practice Location Address
First Line	:	7824 VINEYARD CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182
Country	:	US
Telephone Number	:	817-918-3485
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JESUS H VALDES
Credential	:
Telephone Number	:	817-918-3485

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	05/28/2015

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Directions to “EJV HOME CARE SERVICES, LLC ” Practice Location

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