Healthcare Provider Details

I. General information

NPI: 1073079539
Provider Name (Legal Business Name): JADE DKR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 NW LOOP 410 STE B
SAN ANTONIO TX
78230-5105
US

IV. Provider business mailing address

239 BELMONT # B
SAN ANTONIO TX
78202-3012
US

V. Phone/Fax

Practice location:
  • Phone: 210-521-1244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY WINN
Title or Position: VICE PRESIDENT
Credential:
Phone: 210-385-9500