Healthcare Provider Details

I. General information

NPI: 1790339547
Provider Name (Legal Business Name): JMD EXCELSIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MEADOW PARK
MOUNT VERNON TX
75457
US

IV. Provider business mailing address

502 MEADOW PARK
MOUNT VERNON TX
75457
US

V. Phone/Fax

Practice location:
  • Phone: 903-537-4857
  • Fax:
Mailing address:
  • Phone: 903-537-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIE COQ-LATORTUE
Title or Position: MANAGER
Credential:
Phone: 903-537-4857