Healthcare Provider Details

I. General information

NPI: 1255395299
Provider Name (Legal Business Name): J-MAG ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S MCKINNEY ST
MEXIA TX
76667-3644
US

IV. Provider business mailing address

608 S MCKINNEY ST
MEXIA TX
76667-3644
US

V. Phone/Fax

Practice location:
  • Phone: 254-562-9554
  • Fax: 254-562-7097
Mailing address:
  • Phone: 254-562-9554
  • Fax: 254-562-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number18000
License Number StateTX

VIII. Authorized Official

Name: MRS. MARY ANN GOODALL
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 254-562-9554