MEDICARE: JANE KELLEY ENTERPRISES

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	:	1801178009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE KELLEY ENTERPRISES

Provider Business Mailing Address
First Line	:	625 W FATE MAIN PL
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-6784
Country	:	US
Telephone Number	:	650-678-0786
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 FOREST LN
Second Line	:	101A
City	:	DALLAS
State	:	TX
Zip	:	75243-5900
Country	:	US
Telephone Number	:	214-327-5100
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PARRISH POTTS
Credential	:
Telephone Number	:	214-327-5100

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/20/2011

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