Healthcare Provider Details

I. General information

NPI: 1487918892
Provider Name (Legal Business Name): JIREH LIVING ASSISTANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 PRESTON AVE
PASADENA TX
77505
US

IV. Provider business mailing address

PO BOX 8165
PASADENA TX
77508-8165
US

V. Phone/Fax

Practice location:
  • Phone: 281-827-2675
  • Fax: 713-583-2003
Mailing address:
  • Phone: 281-827-2675
  • Fax: 713-583-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberNA08637069
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIGDALIA ITZEL OLMOS
Title or Position: PRESIDENT
Credential:
Phone: 281-827-2675