Healthcare Provider Details

I. General information

NPI: 1669615068
Provider Name (Legal Business Name): J-SHALOM HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 JUNCTION RUN
MESQUITE TX
75181-4409
US

IV. Provider business mailing address

1416 JUNCTION RUN
MESQUITE TX
75181-4409
US

V. Phone/Fax

Practice location:
  • Phone: 469-592-2669
  • Fax: 972-591-4589
Mailing address:
  • Phone: 469-592-2669
  • Fax: 972-591-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. OKUNBOR ALFRED-IYAMU
Title or Position: OWNER
Credential:
Phone: 469-592-2669