Healthcare Provider Details

I. General information

NPI: 1740555440
Provider Name (Legal Business Name): TJA MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 SANTE FE STREET
CORPUS CHRISTI TX
78404-1857
US

IV. Provider business mailing address

1600 AIRPORT FWY STE 503
BEDFORD TX
76022-6882
US

V. Phone/Fax

Practice location:
  • Phone: 361-444-6888
  • Fax: 361-252-0096
Mailing address:
  • Phone: 210-375-5914
  • Fax: 210-375-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KYLE SMITH
Title or Position: CEO/OWNER
Credential:
Phone: 210-375-5914