Healthcare Provider Details

I. General information

NPI: 1124716238
Provider Name (Legal Business Name): JB AT-HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19850 HAVEN CLIFF LN
CYPRESS TX
77433-4726
US

IV. Provider business mailing address

19850 HAVEN CLIFF LN
CYPRESS TX
77433-4726
US

V. Phone/Fax

Practice location:
  • Phone: 346-218-3594
  • Fax:
Mailing address:
  • Phone: 346-218-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONATHAN BETANCOURT
Title or Position: AMBR
Credential:
Phone: 346-218-3594