Healthcare Provider Details

I. General information

NPI: 1922445105
Provider Name (Legal Business Name): J JIREH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E W M WATSON BLVD
DAINGERFIELD TX
75638-2013
US

IV. Provider business mailing address

507 E W M WATSON BLVD
DAINGERFIELD TX
75638-2013
US

V. Phone/Fax

Practice location:
  • Phone: 903-645-3915
  • Fax: 903-645-2288
Mailing address:
  • Phone: 903-645-3915
  • Fax: 903-645-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000000
License Number StateTX

VIII. Authorized Official

Name: MR. TIMOTHY C THORNTON
Title or Position: MEMBER
Credential:
Phone: 903-746-5369